Tag Archives: health care

So What Exactly is Wrong With “Single-Payer” Healthcare?



About a month ago, I posted a blog (click here to read) making the case that Obamacare has failed to achieve its primary objective of providing affordable healthcare for all Americans. While 17 million more Americans now have health coverage under Obamacare, it is far from affordable and there are still almost 30 million Americans who lack any form of healthcare. My suggestion was to repeal Obamacare and replace it by expanding Medicare and Medicaid, so that all Americans would be guaranteed access to basic healthcare.

The reaction to the blog was swift and sometime acerbic. Comments split pretty much along party lines, but by far most of those who opposed my proposal did so by criticizing it as a “single-payer” system. I was not surprised by that, but that argument is an old dog that just won’t hunt any longer.

You see, “single-payer” is a dog-whistle phrase the insurance industry – and their lobbyist friends – created and have used for decades to protect their turf in the healthcare business. The “single-payer” concept has become a code-word derisively repeated ad nauseam by the insurance industry and its supporters, arguing that “single-payer” is a dark conspiracy of the part of the government to usurp the freedom and right of Americans to select a personal healthcare provider and manage their own healthcare.   

The strategy employed by the insurance industry in this deceitful, greed-driven approach has been to shift the focus away from the need and right of individuals to access affordable healthcare and instead, make it a debate about individual freedom. That’s a nice trick if you can pull it off, but the insurance companies along their well-funded friends have done it.

For decades, the idea of a single-payer healthcare system has been metaphorically the “third-rail” of politics that was so charged with controversy that politicians were afraid to touch it. We see how terrified politicians are to take on the NRA and responsible gun control; well it has been the same with politicians taking on the insurance industry with a single-payer system of healthcare. The chief reason President Obama was willing to accept the insurance industry centered cumbersome system of “insurance exchanges” that are at the core of Obamacare was because he feared taking on the myths of “single-payer” head on. The result is that the insurance companies get their way and their profits and the rest of us are stuck with a muddled, inefficient and high-cost healthcare system. And millions more Americans still lack access to basic healthcare.

So What Really is a Single-Payer System?

A single-payer healthcare system is simple. Under such a plan the government would collect the taxes and premiums needed to fund universal healthcare. The government would then contract with and reimburse private doctors and hospitals for the healthcare services they provide.

What would such a plan look like and how would it work?   

Well, many may not realize it, but Medicare is an example of this dreaded single-payer system. Medicare has proven to work well and covers millions of Americans – including me — without a loss of freedom or choice. Anyone covered under Medicare has the right to choose any doctor or healthcare provider they desire; so long as that doctor or hospital accepts Medicare. The most recent survey determined that over 90 percent of all doctors and virtually every hospital accepted Medicare payments.

It should be noted that Medicare gives those covered the freedom to not only select their personal provider, but virtually any type of medically necessary service. For example, Medicare covers the reasonable costs of doctor, hospital, preventative care, long-term care, mental health, reproductive health, dental, vision, prescription drug and medical supply costs. Contrary to what critics of the single-payer system claim, Medicare actually expands the freedom of individuals to manage their healthcare, because it lowers the financial barriers to selecting the doctor or hospital they choose.  

Those fearful of a single-payer system might suggest that such an all-encompassing government program would be inefficient and costly. Based on the history of other government programs, that might seem logical, but the reality is that the administrative costs for Medicare are at about 2 percent of total services. At the same time, the overall embedded administrative costs in the private healthcare system amount to over 30 percent of the services provided.

The insurance industry and its supporters argue that expanding the single-payer concept of Medicare and Medicaid to all Americans would bankrupt the system, but the truth is it would secure the financial viability of both programs. The system could be funded with premiums paid (based upon ability) by those covered and employer health taxes (employers would actually save money by not being required to provide coverage), but the most significant funding would come from savings obtained by replacing the current system of patchwork coverage. America now has the most inefficient and highest cost system of any industrialized nation; while failing to provide coverage for all citizens. Redirecting the expenditures from this failed private system would provide more than adequate funding for the single-payer Medicare and Medicaid systems. Furthermore, with everyone covered under the same plan, the government would have the clout to monitor and control the costs of services and medication.

The bottom line is that it is all well and good to discuss and debate whether all Americans should have a right to basic healthcare and if expanding Medicare and Medicaid is the way to provide it. However, to base opposition to these questions solely on the “evils” of a single-payer system is to fall prey to the self-serving, greedy and disingenuous arguments of the health insurance industry.  


Malpractice For All In The Health Care Coverage Waivers

Obama Administration Shirks its Duty but There’s More Than Enough Blame to Go Around

Quietly, without fanfare or publicity, the Obama Administration on September 24 granted health care coverage waivers to McDonald’s, the international burger giant, and 29 other organizations. As Drew Armstrong of Bloomberg Business News reported, these waivers mean that “Nearly a million workers won’t get a consumer protection in the U.S. health reform law meant to cap insurance costs because the government exempted their employers.” The news of these waivers was not publicly discovered until October 8 and created a firestorm of charges and counter-charges.

In essence, without the waivers, the companies would have been required to provide covered employees with a minimum of $750,000 in coverage in 2011. The bottom line is that the companies simply did not want to provide this health care coverage to their employees. And the ultimate result is that their employees get stiffed, or should I say, deep-friend?

The reality is that the Obama Administration crumbled in the face of blackmail and bludgeoning threats from these employers. McDonald’s and the other companies threw up thinly veiled threats that – unless granted the coverage waivers – they would simply terminate all coverage for their employees. These penny-pinchers took the position that they would prefer to pay a fine to the government for not providing coverage, because it was cheaper than providing the actual coverage. Because the government-sponsored alternative health care program is not scheduled to be implemented until 2014, these million workers would be without any coverage at all, for up to three years.

The companies used the mid-term election campaign to blackmail the Obama Administration into capitulation on the health care waivers. They recognized, and rightly so I would add, that the Democrats would not want the publicity of  a million-plus workers losing health care coverage – “because of the Obama health care plan” – right in the middle of an election in which they are already in trouble. Despite their callous disregard for the well-being of their employees, McDonald’s and the other companies surmised that terminating coverage for their employees would put more media and political heat on the Obama Administration than on their own selfish actions.

So as a result, contrary to the intent of the health care legislation, millions of Americans will be forced to continue to face health care risks with minimal and inferior coverage.

Casting a Few Well-Placed Stones

So who do we blame here? Do we fault the Obama Administration for being gutless in the face of pressure from these companies and for making a political rather than principled decision? Do we fault these large, sniveling corporations for being more concerned with the health of their bottom line than the health of their employees? Or, do we fault the Republicans in Congress for their clearly political, narrow-minded obstruction and intransigence to effective health care reform?

The answer of course is – Yes! Yes! Yes!

What we have here is the first of what will be many confusing and conflicting chapters in the implementation of clearly imperfect health care reform legislation. It will not be the last time that we will see employers use loopholes and confusion in the health care legislation in an effort to avoid responsibilities to their employees. It will not be the last time the Obama Administration will cave to political and economic pressure. And, we will continue to see the Republicans (or Tea Partiers by another name) resist effective reform by taking self-serving positions, simply for political gain.

Should we be surprised that an imperfect system produced imperfect health care reform legislation? Absolutely not.

President Obama was so intent on claiming success in the passage of health care reform that he was willing to accept any plan – no matter how convoluted – that Congress would pass. The idea seemed to be that “bad legislation was better than no legislation.” The plan was “we’ll fix it later,” but it was weak leadership and Obama is now paying the price. The Democrats, who dominated Congress, clearly demonstrated that they were no more effective as leaders than the Afghan government. The Republicans demonstrated clear disdain for any ideas that were not their own and they had no ideas of their own. Just being against anything anyone might want to do is not leadership. Corporations were the most consistent and effective when it came to health care reform. They attempted to defeat health care reform and now are attempting to circumvent it based on their eternal belief that “profits come before people.”

And the Moral of the Story …

Leadership starts with clearly defining what is to be accomplished and eliciting acceptance among your followers. For that reason, leadership is most effective when the focus is constantly on the vision to be achieved while the efforts are concentrated on the little things that make success possible.

The vision of health care reform was based on “the right of all Americans to receive basic health care.” Obama failed as a real leader here because he failed to clearly define and gain acceptance of the vision. He compounded his problems losing focus on the vision, allowing the incoherent Democrats in Congress to concentrate on the little things and by allowing the obstructionist Republicans to actually define the debate.

The result was a complicated, convoluted and ineffective plan for health care reform. And, this opened the door for corporations to do what they do best and that is to look out for themselves, even – if not always – at the expense of all others.

The reality is that there are no winners here — especially those who need and deserve basic health care coverage — because America lacks truly effective, ethical leaders and that, in my view, is what is wrong with America today.

Leadership Lessons Learned from the Health Care Debate

 This blog is not about the “health care reform” debate currently banging against the walls in Washington, but rather, from a personal and business leadership perspective, what can be learned from the debate. One thing that won’t be learned by tuning in to the congressional cacophony is how to provide and pay for effective health care for all Americans. (I do have the answers for that, but I am keeping them secret!)

The health care reform debate is a microcosm of the battles that often take place between those trying to get things done (entrepreneurs) and those trying to maintain the status quo (bureaucrats). Unfortunately, as in most of these battles, the bureaucracy is winning. Not because the bureaucracy is on the right side, but because those proposing change often allow the bureaucrats to define the debate.

In doing so, those opposed to healthcare for all Americans have successfully centered the debate on what they call “health care reform.” The reality is that the debate is not about reform at all.

“Reform” is what you do to change an existing system. When there are over 46 million Americans who do not have any type of healthcare coverage, you do not have an existing system of national health care. There is nothing to reform, because there is no system.

When the opponents (bureaucrats) of an initiative – in this case national health care – are allowed to focus the discussion on “reform,” then the debate becomes defused with extraneous options that deflect attention from the real issue.

That’s why successful leaders learn to stay focused on the most important issue they seek to solve or achieve. They ignore the details and distractions of those opposed to the effort unless and until there is agreement on the main issues, the big picture. Whenever you allow the bureaucrats to get you dealing with issues that are only tangential to the real issue, you will always lose the battle.

The struggle over health care should not be focused on “reform,” but about “rights.” The complexion of the entire debate would change if the proponents of national health care had made the issue a “health care rights” debate. Opponents would have been put on the defensive and forced to debate the crucial question of:  Do all Americans have the right to receive healthcare?

  • Americans have the right to “life, liberty and the pursuit of happiness.”
  • Americans have the right of free speech.
  • Americans have the right to a basic education.
  • Americans have the right to adequate defense in criminal matters.
  • Americans have the right to privacy.

If the debate had been focused on the proper issue — whether or not Americans have the right to healthcare – the debate would be entirely different. If it had been, what politician (bureaucrat) would stand up and proclaim that only “certain” Americans have a right to healthcare?

The irony is that America – the land of individual rights – is the only country of the 30 largest industrial nations in the world that does not view health care as a right of all its citizens. That is what the debate should be about!

If Americans decide that health care for all individuals in the society is not a right and that only those who can afford to pay for it should have it, then case closed. No need to waste further hot air.

However, unless the proponents can make the debate about the rights to health care, rather than how to pay or provide for it, the discussion will continued to be mired in unanswerable objections of the bureaucrats.

If Americans decide and demand health care as a right and not a privilege, the debate would end, but no national leaders have made this case and instead are kept on the defensive. And the sad truth is, when a leader is forced to defend rather than push an initiative, the bureaucrats will always win.

And the moral of the story … the lesson we can learn is this

To be a leader in life and in business make it a rule to always be the one who is proposing, not opposing. Understand, communicate and focus on the specific objective or initiative you seek to achieve. Make the debate focus on the benefits and value of the plan you propose. This will give you a much better chance of winning the day. Once the debaters decide your objective is worthwhile to achieve, let the others deal with the details, while never allowing them to lose sight of the objective on which all parties have agreed.