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Archive for Sunday, May 10, 2009

Health care overhaul draws groups’ competing demands

May 10, 2009

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Patients and doctors. Small businesses and multinationals. Retirees, workers and insurance companies.

Some have more money and clout. All have something in common when it comes to overhauling health care: a huge stake in the outcome.

Their competing demands will help determine what happens as Congress writes legislation to reshape the nation’s $2.5 trillion health care system to bring down costs and cover 50 million uninsured people. If the whole undertaking starts to fall apart, look to opposition from one or more of these groups as the reason why.

All say their goal is for everyone to have access to quality and affordable care. Beyond that, consensus breaks down.

A look at 10 groups with the most influence, or most at stake, in the health debate, and what they want and are trying to avoid:

Workers:

Some 60 percent of people under age 65 get health care through an employer. But employers don’t have to offer health insurance, and as the economy frays, some are dropping it. Labor unions want to require employers to help pay for coverage for their employees.

Unions also believe the path to affordable care runs through a new public insurance plan that would compete with private plans. Middle-class workers, for the first time, would have the option of government insurance. Proponents of this approach, already embraced by President Barack Obama and many Democrats, believe it would drive down costs for all.

People with health conditions:

A common complaint about insurers is that they won’t cover people with existing health conditions or that they charge them too much. Patients’ advocacy groups want to require insurers to cover all comers, not just the healthy, and limit what they can charge the sick. They contend that would spread risk and costs throughout the population.

Older people:

Among the top goals for AARP is ensuring health coverage for people age 50-64 (at 65 they can get Medicare). That could be done by allowing middle-aged people to buy into Medicare. AARP also is eager for Congress to fix the coverage gap in the Medicare drug benefit that patients fall into once their prescription expenses exceed about $2,700.

Uninsured people:

The estimated 50 million uninsured people in the U.S. don’t have lobbyists, but various advocacy groups aim to speak on their behalf. The liberal group Health Care for America Now says any health overhaul should mean coverage for everyone by including a public plan, basing out-of-pocket costs on ability to pay and providing a standard benefit with preventive care and treatment for serious and chronic diseases.

Insurance companies:

For private insurers, the bogeyman is competition from the government. They contend a public plan would drive them out of business. To stave that off, the industry is offering to curb its practice of charging higher premiums to people with a history of medical problems, as long as Congress requires all Americans to get insurance.

Small businesses:

Opposition from small business helped kill a health care overhaul during the Clinton years. Their top goal remains the same: to avoid any kind of requirement for employers to provide health care. The National Federation of Independent Business says that is unacceptable and favors subsidies to help people buy insurance. Small businesses want to make the same tax breaks for health insurance available to all, not just those who get coverage through an employer.

Big businesses:

Even though most big businesses offer health care to their employees, they strongly oppose an employer mandate, fearing the government would start dictating what kind of policies they could offer. Businesses want to avoid taxes on the health insurance benefits.

Hospitals:

Hospitals worry that a new government insurance plan would reduce the fees they can collect. They support requirements for individuals and employers to purchase insurance so “everyone plays a role in making sure that there’s coverage,” says Tom Nickels, a senior vice president at the American Hospital Association.

Drug companies:

The drug lobby opposes a government insurance plan and has joined the advocacy group Families USA in proposing to cover more of the uninsured by expanding Medicaid, the federal-state insurance program for the poor. Pharmaceutical companies support federal subsidies to help middle-class people unable to afford insurance. Drug companies oppose efforts to squeeze bigger discounts from them under Medicaid.

“We don’t want bureaucrats making the decisions about what medicines can be used by the patients of our country and that’s the end result of a pure public plan,” says Billy Tauzin, head of the Pharmaceutical Research and Manufacturers of America.

Comments

just_another_bozo_on_this_bus 5 years, 7 months ago

And by slam-dunk margins, single-payer satisfies the needs of the greatest number of people described above, including both small and big business. The only ones who don't want single payer are the companies who have control of the healthcare system now, and are bungling it badly because that makes them fabulously wealthy.

just_another_bozo_on_this_bus 5 years, 7 months ago

"There are only three single-payer systems in the world — Medicare, Canada, and Australia — and all of them achieve most of their alleged savings by denying access to treatment."

Any system that can be devised will have to ration healthcare to some extent. I'll take one that rations it in order to stay within budget (a budget determined by elected representatives) over one that rations just to maintain obscene profits.

just_another_bozo_on_this_bus 5 years, 7 months ago

No one wants to hear a bureaucrat tell them "no," whether they are employed by the government or an insurance company. What's your point?

Flap Doodle 5 years, 7 months ago

The O'dude will go which ever way he thinks will bring in the most voters.

Ryan Neuhofel 5 years, 7 months ago

This article perfectly portrays how politicians will approach the health care issue - through interests of employers, insurance lobbies, political groups and bureaucrats - but it fails to discuss the true cause of medical inflation, caused by the over involvement of the aforementioned. However, emotional political arguments of "fairness" and "equality" always trump bland analysis of basic economic realities.

I wrote a blog about the very obvious cause of medical inflation and the resultant uninsured if anyone is interested.

Ryan Neuhofel 5 years, 7 months ago

Pilgrim and Bozo,

You are correct that ANY system governing a scarce resource will have "rationing" (more accurately: allocation of resources), but emotional arguments about which third-party boogeyman (government or private health plans) should manage our daily health care are not the only options! . . . .despite the "managed care" system politicians have created over the past 60 years.

Also, there is a stark difference between "costs" and "prices". Government intervention can certainly control "prices" but that does NOT change the "costs" (labor, goods, etc.) required to provide care without significant ramifications.

notajayhawk 5 years, 7 months ago

just_another_bozo_on_this_bus (Anonymous) says…

"The only ones who don't want single payer are the companies who have control of the healthcare system now, and are bungling it badly because that makes them fabulously wealthy."

The fact that you get laughed at on these boards every time you post your drivel, even in such a workers' paradise as Larryville, gives lie to that statement, boohoozo.

But lying is what you're good at on this subject, isn't it?

"I'll take one that rations it in order to stay within budget (a budget determined by elected representatives) over one that rations just to maintain obscene profits."

I would think that, given the extreme likelihood that you've made it this far living off public assistance, you'd realize the idiocy of that statement, too. So when the budget runs dry three months before the end of the state's fiscal year and they stop paying for everything, that's a good thing, right? Brilliant plan.


Pilgrim2 (Anonymous) says…

"The point is, the government is just as likely to say “no” as an insurance company."

As someone who works in an area of healthcare that is almost entirely taxpayer-funded, I can tell you they say 'no' more often, and for reasons you'd find hard to believe. Not to mention, as I just said, when the amount budgeted by boohoozo's 'elected representatives' a year previously runs out, they stop paying for anything.


I asked this question on another thread, I'll ask again: If government run healthcare is so wonderful, so good at simplifying billing and paying claims in a timely manner and not denying claims for frivolous reasons - then why do so many healthcare providers not take Medicaid? (And before you guess it's because Medicaid pays less, that's not true - they pay more for the same services than private insurers do.)

just_another_bozo_on_this_bus 5 years, 7 months ago

"The point is, the government is just as likely to say “no” as an insurance company."

Insurance companies say no to somewhere between 1/6 and 1/3 of the population of this country, and no other industrialized democracy says no anywhere near as often. That might be somehow acceptable if it actually saved us some money, but even with all that "no" saying, we still spend twice as much as anybody else does for healthcare.

"So if there's little to no difference in the ultimate outcome, there's no reason to let the government seize control of such a large portion of the country's economy."

Well, there is very clearly a very big difference in outcome, so we should no longer allow insurance companies to seize such a large portion of the country's economy because they have performed so very miserably for so long.

just_another_bozo_on_this_bus 5 years, 7 months ago

"Also, there is a stark difference between “costs” and “prices”. Government intervention can certainly control “prices” but that does NOT change the “costs” (labor, goods, etc.) required to provide care without significant ramifications."

A good point, but in the current system, at least 20% of overall healthcare expenditures are nothing but needless froth created for the sole purpose of allowing insurance companies to skim it off the top. We have to get rid of that before the these other issues can really be addressed.

Ryan Neuhofel 5 years, 7 months ago

bozo,

Actually, utilization of third parties health managers or "insurance" (private or public) accounts for 40-60% of health care costs, especially when considering increased administrative costs of health care providers to navigate payment systems by the third party payers.

With regards to "unnecessary" profits by private health plans - I would agree that an unnecessary amount of people's money is filtered through so-called health "insurance" before getting to the actual health care provider (doctor, etc). But, the largesse (and high profits) of the companies was largely created by politicians who encouraged and mandated "managed care" - which funneled nearly every single dollar (90%) of health care dollars through a third-party. Now the same politicians want to become benevolent, "non-profit" health managers. While the "profits" and resultant costs may be slightly lower (5% of the total) in a government ran system, a continued dependence on third-party payer will continue unnecessary medical inflation.

Also, "eliminating profits" in the name of reducing prices or costs has been the status quo in education for the past 50 years - how has that worked out?

just_another_bozo_on_this_bus 5 years, 7 months ago

"While the “profits” and resultant costs may be slightly lower (5% of the total) in a government ran system, a continued dependence on third-party payer will continue unnecessary medical inflation."

Are you advocating eliminating all insurance of any kind to eliminate the "profit" (a term that is really inappropriate with a single-payer plan, BTW) and creating a system where everyone just pays cash out of pocket for their medical care (as Liberty One advocates?) I can see how that's ideologically attractive to some, but would that really improve anything for the 1/3 of our population who currently have no or limited access to healthcare?

"Also, “eliminating profits” in the name of reducing prices or costs has been the status quo in education for the past 50 years - how has that worked out?"

The purpose of public education is not to reduce prices or costs-- its purpose is to provide access to quality education to everyone, regardless of their socioeconomic background.

Ryan Neuhofel 5 years, 7 months ago

bozo,

You are fighting a strawman - I never advocated the elimination of insurance (in a true form) or the elimination of public assistance for health care. I am merely stating that medical inflation, the main cause of the uninsured, is inherent when any third-party (profit or not) is used to pay for health care expenses (now 90% of total) - whether paying for oneself or using taxpayer monies (assistance).

Assuming the same level of care is provided, "eliminating profits of private health plans" and transferring the management fully to "public" plans (already at 50%) will not significantly reduce medical inflation - the true cost difference is negligible. Furthermore, will the government employees managing our health care in a single payer system be getting paid (profiting) or be working charitably?

You say, "Provide access to quality education to everyone, regardless of their socioeconomic background". I absolute agree in providing universal quality education opportunities, but the intentions and "purpose" have not equaled results. Has our current non-profit system (which is universally accessible) provided a good education for a reasonable cost? I think the statistics clearly state it has not.

Richard Heckler 5 years, 7 months ago

Make HR 676 available to all taxpayers and let them make the choice. Let myself and others have a choice instead of being forced to use incompetent insurance companies.

Why is it that those who want THEIR tax dollars paying for THEIR health coverage cannot have the choice to do so?

60% of those insured are covered with taxes = a big slice of the pie = $1.2 trillion. This $1.2 trillion tax dollar gravy train is what the insurance companies are concerned about. Corporate america loves socialism. Apparently so do many on this chat board.

Isn't odd that close to $6 million tax dollars is used to pay for D.C. politicians health insurance yet they deny taxpayers the same luxury? All of these politicians could well afford their own yet WE TAXPAYERS will be paying for politicians health insurance from retirement until the day they die. Why is this?

Richard Heckler 5 years, 7 months ago

HR 676 National Health Insurance makes americans more employable and opens doors for small business ventures.

What could possibly be more middleclass american? Providing americans with the choice of National Health Insurance. HR 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, and long term care.

A family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs.

HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

Let’s move into this plan slowly. Why not go into this matter that leaves the choice open to citizens. This program could begin by moving all of the following into the program and bringing those tax dollars with them. • everyone on social security and their dependents • all disabled veterans • all Iraq/Afghanistan veterans • all government employees including active duty military stationed stateside • all currently uninsured

What this approach does is leave open the choice for all others to either make the change or continue with their current insurance provider.

Face it an HR 676 will save large amounts of tax dollars on all federal employees,vets and those currently uninsured.

Are Americans ready for HR 676? Of course they are.

Not only that HR 676 makes all Americans more employable. Not to mention the opportunity it creates for new small business ventures.

So many would not venture off to becoming a small business entrepreneur due to the cost of maintaining insurance for their families so now opportunity knocks. Now we're talking long term economic growth for americans by way of long term employment.

  • Employers should not be forced to pay up. There are enough tax dollars available in the USA to cover the cost easily:

*60% of insured are covered with taxes = a big slice of the pie = $1.2 trillion

*Cut subsidies going to very wealthy industries = Another sizeable slice of the pie. Let's get them off welfare! Instead have those tax dollars care for americans thus attracting industry and new jobs at the same time which creates new economic growth.

*WHY wouldn't TAXPAYERS want the choice to useTHEIR tax dollars to cover the expense of THEIR own medical insurance? What in the world is wrong with that? What could be more american?

Again make HR 676 available to all taxpayers and let them make the choice.

Richard Heckler 5 years, 7 months ago

Barrypenders,

60% of those insured are covered with taxes = a big slice of the pie = $1.2 trillion. This $1.2 trillion tax dollar gravy train is what the insurance companies are concerned about. Corporate america loves socialism. Apparently so do many on this chat board.

HR 676 would save taxpayers tons of money considering the number of city,county,state,federal and school district employees on the planet.

Why shouldn't I have the choice to spend MY tax dollars on MY health insurance? Better spent on me than all the expenses retired presidents accrue such as Clintons $78,000 phone bill and now the Bush family has two on the taxpayer payroll.

Ryan Neuhofel 5 years, 7 months ago

merrill,

I fully promote increased choices in health care (third parties or directly) for every American. Despite your exhaustive posts promoting HR 676, it is NOT a truly pro-choice plan. Private individuals cannot even choose private health plans (insurance or managed care) outside of their employer offerings without paying an after-tax penalty. HSA have deceased the "after-tax penalty" for some expenses, but not for insurance premiums.

notajayhawk 5 years, 7 months ago

merrill (Anonymous) says…

"Why shouldn't I have the choice to spend MY tax dollars on MY health insurance?"

You do have the choice on where to spend your dollars on healthcare.

Stop asking for the right to choose how I spend mine.

notajayhawk 5 years, 7 months ago

And incidentally, still waiting for someone to answer the question as to why so many healthcare providers don't accept Medicaid, Medicare, etc.; if government run reimbursement is so superior, how come they all don't take it?

No takers? merrill? boohoozo?

[crickets chirping]

Ryan Neuhofel 5 years, 7 months ago

nota,

As a physician whom is preparing to open my own practice in the near future (Family Medicine), maybe I can provide some insight into your question about decreasing acceptance of Medicare/Medicaid. Basically all health plans (so called inurance) are a large hassel that double overhead costs of nearly all medical practices. Government plans (Medicare and Medicaid) typically pay less (10-30%) for any given service versus private payers. Sometimes (increasingly) the cost of providing a service (procedure, etc.) is higher than the actually payment provided by the health plan! But the payment differences are just a small reason doctors are declinding to contract with Medicare/Medicaid. The larger reason is the increased "fraud" liability (much higher fines for record keeping errors, etc.) and resultant meticulous inspection by government "accountability" officials (in the name of controlling costs).

notajayhawk 5 years, 7 months ago

neuhofel;

As a Medicaid provider, I'm not not too sure what you're referring to when you say "typically pay less." They pay me more. And I've seen billing from most of the local hospitals and many medical practices that also reflects higher rates being paid by Medicaid and Medicare than private insurers like Humana and Coventry pay.

"The larger reason is the increased “fraud” liability (much higher fines for record keeping errors, etc.) and resultant meticulous inspection by government “accountability” officials (in the name of controlling costs)."

On that I completely agree (and I've written about that before). The really ludicrous part is that I've also worked in state-operated facilities, and they don't hold their own employees to the same standards as they insist on from providers they simply reimburse.

There's also that little detail that government plans are not required by law to maintain reserves or even to pay claims - when the amount the legislature budgets for the year runs out, the legislature might approve additional funds (if there are any), or they just might tell you there's no more money until the next fiscal year.

notajayhawk 5 years, 7 months ago

A Medicaid Tale (A true story dealing with the ‘efficiency’ of government-funded healthcare)

A friend of mine called me yesterday, telling me about a collection of five letters he had received from KMAP. A little background: Early last year, while he was unemployed, they signed up for and received TANF – for one month. But since they were on the rolls, they also got Medicaid – for three months, since it was retroactive to the first of the month they applied, and the processing at Medicaid takes much longer than it does for cash assistance, so it took longer to stop the Medicaid. Then they were automatically put on TransMed, a Medicaid program for TANF recipients that return to work, for 6 more months, with a possibility of 6 more depending on income. But since the wife was pregnant, she was put into Medicaid-P (for pregnant women), and at the 6-month point the husband and their other child were renewed (despite his income) for TransMed until the end of April this year. Back in February or early March, they got a renewal notice, and while they didn’t expect to get approved, he was actually making less at renewal time than he had been at the 6-month point (his work is kind of seasonal), so he figured what the heck and sent everything in, well before the deadline (April 1st).

When April 30th rolled around and he hadn’t heard anything, he called and was told they had received everything they needed, but they were very much behind on renewals, so no notices had gone out yet. The next day one of the children was sick, and on the 2nd they had to pay over $100 out-of-pocket for prescriptions because the Medicaid came back inactive.

[continued]

notajayhawk 5 years, 7 months ago

[continued]

Then, as I said, yesterday they got 5 letters. The first they opened said that the baby (born last year) had been enrolled in Medicaid – despite the fact that they’ve been paying all the baby’s claims since he was born. The second was the standard ‘Since you’re getting Medicaid, you have to notify us if…” Number three was a note that there have been some changes to their Medicaid coverage, which would be explained in a ‘separate letter.’ The fourth stated that the parents were no longer eligible due to the husband’s income. The final letter said the kids would continue to be covered, one on Healthwave 19 (the free program) and the other on Healthwave 21, which requires a premium payment. Their premium would be $0.00.

So, just to recap:

  • The ‘single-payer’ system is a myth. Various members of his family were enrolled in at least four different programs just within the last year, all under the blanket term ‘Medicaid.’

  • The parents were denied coverage based on the husband’s income, which was lower than what it was when they were approved for coverage 6 months prior.

  • The two kids were placed in two different programs, because one required a premium payment – despite the fact that the premium was zero.

  • They had claims denied for the sole reason that the people at Healthwave couldn’t process a renewal in over 5 weeks.

  • It took five pieces of correspondence, all apparently mailed together, all including copies in Spanish, to inform them that 1) the parents were no longer covered, 2) the kids were, 3) that those changes had been made, and 4) that as recipients of state aid they were required to notify the state of certain changes. It would seem numbers 1 & 2 could have been combined, 3 was completely redundant and unnecessary, and 4 should have been a standard part of any of the others.

And this is what you guys want for everyone? No thanks.

Ryan Neuhofel 5 years, 7 months ago

nota,

I'm not sure what type of health care you work in, but Medicaid certainly has the lowest fee schedule of all third-party payers in medicine (all fields) - varies among states somewhat. Medicare does pay better than a few private health plans, but average at best when compared to most private payers.

http://www.ama-assn.org/amednews/2009/05/04/gvsa0504.htm

However, I agree that many other factors discourage doctors contracted with government plans. They are notorious (especially Medicaid) at delayed payments - although KS Medicaid is typically better than most.

Overall, I think the whole third-party, managed-care system (public and private) is a waste of resources in most medical services - primary care, ambulatory, etc. It has been the primary driver of medical inflation - despite it's intent to do the opposite.

In fact, I plan on NOT contracting with any third-parties (insurance) in my Family Medicine practice - a direct medical model. I can drastically reduce overhead costs and charge 50-70% lower fees than what a third-party would pay (ultimately the patient themselves through premiums). This system can be a huge savings for nearly all patients, when combined with a true catastrophic insurance + HSA. Also, I will be working directly for my patients and NOT a third-party payer - hopefully allowing me to provide much better care. It will provide "uninsured" patients access to simple, affordable primary care.

notajayhawk 5 years, 7 months ago

neuhofel;

I wish you luck with your undertaking - it's a great idea and I really hope you can pull it off. I'm old enough to remember having a family physician whose practice was on the first floor of his home, and the only other employee was his nurse - who happened to be his wife.

I think you're being overly optimistic on your projected savings, though. Even the infamous NEJM study that came up with that 30% 'administrative' costs (through rather questionable methodology) figure didn't blame all that overhead on dealing with third-party payers. Even if you don't take government payments, there are still going to be costs associated with regulatory compliance, there's the (rather ungodly) cost of insurance, and just the cost of setting up a practice (phones, computers, copiers, etc.) have gotten out of hand.

I'm not in private practice, so it's up to the agency that employs me what plans we take - but almost all of it is government funded. I've also been a consumer of government-funded plans from time to time, and I have friends and family that still are. The story you linked to compares reimbursement rates between Medicaid and Medicare, and how both are falling behind inflation, but says nothing I could find about how private insurers compare to either. Sorry, but in my experience (as a provider and a consumer) private companies negotiate and pay lower rates.

Ryan Neuhofel 5 years, 7 months ago

nota,

From the doctors perspective, most traditional outpatient practices have 2-4 employees (or contractors) just to collect payment from health plans - coding, billing, reviewing EOBs, challenging rejections, resubmitals, revisions, etc. Accepting full payment directly from patients at time of service, could eliminate the majority of office/clerical staff - decreasing labor costs by at least 50% and untold savings in effeciency/paperwork. I plan on having only 1 full-time employee (MA or RN) and utilizing technology (internet, email) to automate/simplify many services (scheduling, payment, communcation, etc.). There are an increasing number of direct-medical models around the country (mostly primary care) that are drastically decreasing cost of care (compared to private insurance fees) while spending more time with patients - and profitting equal or better than a third-party model. Basically the math doesn't lie. Qliance in Seatlle is one great example (Qliance.com) - many others found online, but none yet in Midwest.

From the patients perspective, the savings are obvious. Most High Deductible Health Plans (HDHP) premiums are 30-50% lower than managed care (HMO/PPO) plans. Out of pocket expenditures for services may be slightly higher when compared with "insurance" co-pays, but I plan on charging similar "rates per time" as a traditional $30 co-pay for a 10 min doctor visit. My charges for basic lab and procedures will be at least 50% less than avearge "insurance fees". The savings are even improved when combined with an HSA.

Basically, I took an oath to work for my patients and NOT to maximize an insurance corporation profit or a bereaucrat's budget and I will do everything to uphold that.

Ryan Neuhofel 5 years, 7 months ago

by the way, I'm not accepting ANY payment from third-parties . . government or private.

just_another_bozo_on_this_bus 5 years, 7 months ago

There is a certain appeal to a pay-as-you go system, and I think it's possible to work it into whatever system gets implemented, but on a very limited basis.

If the healthcare system were exclusively pay-as-you-go, the situation would look exactly as it currently does-- anyone with less than a middle-class income would continue to be excluded from anything but emergency care, and if you get any injury or disease that is costly to treat, only the very wealthy will have access to care.

Ryan Neuhofel 5 years, 7 months ago

bozo,

Transitioning to more "direct payment" (pay-as-you-go) for the majority of medical care (primary, routine, maintenance, minor) combined with a true (catastrophic) insurance plan would drastically reduce cost (price) of care. . . and this would benefit everyone, including the "poor". As simplistic as it may seem, the primary cause of the "uninsured" and "lack of access" are high costs! If a visit to the doctor were cheaper, access wouldn't be an issue for as many people. (no duh!)

Furthermore, direct-medical models do NOT discriminate or choose patients based on "insurance contracts". The entire health care system is designed to accept payments from third-party payers NOT individuals. For many reasons (many legitimate), most medical practices will not provide care to "uninsured". I hope to provide upfront, affordable care to the "uninsured" so they don't have to seek suboptimal care from an understaffed, overwhelmed public health agency or visit the ER unnecessarily.

A more direct-care model will work for the vast majority of people across all socioeconomic classes, ages and health states. Many will argue that people with "higher pre-existing conditions" will not adapt will to this model, but I disagree. Of course, someone with diabetes (or any other chronic condition) will require more frequent care, but why should that person (knowing they will require 4-6 trips to the doctor every year) pre-pay a health plan manger (its overhead and profits) and ultimately rise the cost of their routine care.

I am NOT advocating elimination of insurance (in a true sense: for unexpected events/costs) or government assistance for the "sick and poor". I think we need to re-examine the entire notion that a third-party payment (private or government) system is an efficient, valuable way to delivery health care. I think the past 30 years has clearly demonstrated it has failed miserably.

The vast majority of politicians would oppose such a plan on political grounds. In general, the Republicans would oppose it because of the inevitable loss of profits for private health plans and Democrats would oppose it because they would lose political control over our health care dollars.

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