Hey College Republicans, Single-Payer will set Prices and Pay for Health Care! Motivating Lower Prices a Free Market Fantasy.

It's funny how something you come across earlier in the day comes up again later and oddly ties everything neatly together.

PolitiFact did a great job explaining the concept of a "single-payer" health care system. This line stood out for me, and should really be mentioned every time a Democrat talks about the issue:

According to the group Physicians for a National Health Program, a single-payer national health insurance system is one in which a single public or quasi-public agency sets prices and pays for health care, but the delivery of care remains largely in private hands.

Then I came across this MSNBC interview with a "college Republican," where Mr. Smarty pants confidently pushed a private free market system, claiming only competition will magically lower prices. He had no idea a public agency would step in and set national prices for every kind of treatment. Do conservatives do any research at all, ever:

Behold the GOP's Health Care Profit Driven Vision

It's time to take a look at the never-ending nightmare of GOP health care meddling, and how the U.S. system keeps picking the pockets of the Amercian people for their ghoulish bottom line. Hail corporate profits!

GOP ACA Repeal now based on GOP's own Axing of Individual Mandate: Can they get away with this? And get this; “Scott Walker, avowed Obamacare opponent, passes law to shore it up”: yet he also signed off on letting state AG Brad Schimel join the Texas lawsuit to repeal the ACA. Doh!!!

Twenty state attorneys general have filed a new lawsuit that — like the many lawsuits before it — aims to take down the Affordable Care Act ... The suit makes a new legal argument that relies on Congress's recent repeal of the individual mandate penalty. This lawsuit starts from Congress's recent decision to ax Obamacare's penalty for not carrying health insurance, reducing the fine from $695 to $0 — essentially getting rid of the provision.

In previous rulings, the brief argues, the Supreme Court has stated that this mandate is crucial to making the Affordable Care Act work. With the individual mandate penalty killed, the lawsuit argues that the entire law is no longer workable and ought to be struck down.

Or, as the lawsuit itself puts it: "Once the heart of the ACA—the individual mandate—is declared unconstitutional, the remainder of the ACA must also fall."

GOP's Medicare Advantage Con for Profit: The privatization of Medicare promoted through Medicare Advantage has gamed the system, costing $1 billion. This is the GOP's baby, and yet no one is shouting this from the mountaintop:

The U.S. Justice Department recently has been dealt heavy blows in its quest to recover millions in allegedly fraudulent Medicare Advantage payments to UnitedHealth Group. The federal government ditched most of its False Claims Act lawsuit. 

The federal government will only litigate whether the data used to secure more than $1 billion in Medicare Advantage payments was invalid. 

The Justice Department has opened several investigations into the upcoding practices in the Medicare Advantage program. UnitedHealth, Aetna, Health Net, Humana and Cigna's Bravo Health are all under federal scrutiny for potential upcoding issues. Risk scores were created to incentivize plans to cover all seniors ... several whistle-blower lawsuits in recent years that allege health plans have been inflating the scores to collect more funds. The lawsuit claimed UnitedHealth collected payments from false claims that it treated patients for conditions they didn't have, for more severe conditions than they had, conditions that had already been treated, or diagnoses that didn't meet the requirements for risk adjustment.

Insurer Denials to Treat Americans Back Again...: Without the ACA's built-in protections to provide Americans with complete health care coverage, insurers are already denying claims without even looking at them. It didn't take long, did it? Anyone see a problem?

Two leading Senate Democrats asked Aetna to hand over information about its prior authorization process, citing concerns that their practices may have violated federal law ... during a deposition that he never reviewed patient medical records when deciding whether to pay for treatment.

Wyden and Murray said Aetna's behavior in the California case "appears to violate safeguards put in place by the Affordable Care Act," which require insurers to allow beneficiaries to review their file.Aetna has acknowledged that six state regulators are looking into its prior authorization practices

The critique comes as congressional Democrats worry expansion of insurance plans that don't comply with Affordable Care Act coverage protections will lead to a higher number of similar cases. The Trump administration has lifted the time-limit on short-term plans, a move that critics say will pit these plans in direct competition with traditional insurance. "These junk plans skirt key consumer protections included in the Affordable Care Act that bar insurance companies from ignoring appeals, denying care or charging people more because of their age, gender, or because of a pre-existing condition," the senators' release said.

GOP's Rube Goldberg "Group" Insurance Plan to Raise Rates, Reduce Coverage and Promote Junk Policies: Nuff said...

As many as 4.3 million people are projected to leave the individual and small group insurance markets to enroll in association health plans over the next five years ... premiums in the ACA individual and small group would rise as much as 4% between 2018 and 2022, according to healthcare consulting firm Avalere Health ... projected that another 130,000 to 140,000 people would become uninsured in five years, compared to current law. 

The Trump administration in early January proposed a rule that would allow more small businesses and self-employed workers to band together to buy insurance under association health plans ... but many health policy experts have argued that association plans not required to offer the same benefits and consumer protections as ACA-compliant plans ... with fewer healthy members to balance out the cost of the sicker, older enrollees, Avalere said.

It's Back - That "Preexisting Condition" Killer Gets Trump Endorsement: It's called a "short-term" plan...that could last forever. Republicans are again, trying to separate the deserving healthy from the burdensome sick, just like Jesus would have done:

According to the proposed rule on short-term plans, plans that don't fully comply with the law's coverage mandates ... people can re-apply for these policies. They would not be automatically renewed since they would have to face screenings for chronic and pre-existing conditions. Should enrollees pass these underwriting screens, they could hold the short-term plans for as long as they want, which critics say pits these plans directly against traditional insurance. They also pose higher out-of-pocket costs for enrollees and some exclude coverage mandated by the ACA, such as maternity care ... do include annual coverage caps.

Going Back to our Future-Preventable Deaths Return with a Vengence: No, Health care was not better before the Affordable Care Act. In fact, it was a killer:

Little by little, the Trump administration is dismantling elements of the Affordable Care Act and creating a health care system that looks more like the one that preceded it. But some states don’t want to go back and are working to build it back up.

Congress and the Trump administration have reduced Obamacare outreach, weakened benefit requirements, repealed the unpopular individual insurance mandate and broadened opportunities for insurers to offer inexpensive but skimpy plans to more customers.

Last week, the administration released its latest proposal along these lines, by changing the definition of so-called short-term plans that don’t need to follow any of the Obamacare requirements, including popular rules that plans include a standard set of benefits, or cover people with pre-existing conditions. Taken together, experts say, the administration’s actions will tend to increase the price of health insurance that follows all the Affordable Care Act’s rules and increase the popularity of health plans that cover fewer services. The result could be divided markets, where healthier people buy lightly regulated plans that don’t cover much health care, lower earners get highly subsidized Obamacare — and sicker middle-class people face escalating costs for insurance with comprehensive benefits.

Walker says Reinsurance Plan using Taxpayer Money...is "Market Driven?"

Scott Walker just said that government intrusion in the free market doesn't really "distort the market" after all. That runs counter to everything Republicans have been saying for the last 50 years or more.

But even better, Walker indirectly said why he unabashedly thinks his $4.5 billion taxpayer handout to Foxconn wasn't hypocritical or a complete contradiction of conservative free market principles:

Walker got applause when he told doctors he wants a state law to protect those with preexisting conditions. Federal law already does.

Let's be clear, Walker is talking about taxpayer money, and he wants to "distort market prices" downward with it:

1. $200 million in state and federal money to stabilize the state's Obamacare market and hold down rising insurance premiums.

2. $150 million in federal money and $50 million from state Medicaid savings.

You can't make this stuff up. Quoting Walker:

"This is a market driven way to help drive down premiums..."

I can't wait to see RightWisconsin or the MacIver Instute fellows twist themselves into pretzels trying to explain Walker inadvertent moment of honesty. 

Walker to the Rescue, Fixing another Self-inflicted Republican Problem? Of course:

Walker (said), "No matter what happens in the future in Washington (D.C.), no matter what changes they do or don’t make to the Affordable Care Act in Wisconsin, going forward preexisting conditions will be covered so we don’t ever have to worry."

Walker won't say this, but he's fixing a problem that might be created by Republicans and Wisconsin embarrassment Dumb Ron Johnson:

Walker's plan would only kick in if similar protections in the Affordable Care Act are repealed ... Sen. Ron Johnson tried and failed to have those protections removed last year. Walker wants federal permission to set up a reinsurance fund to offset the costs of those with expensive conditions.

Pointing out the obvious, and once again demonstrating why Democrats are better government managers than government hating Republicans:

Assembly Minority Leader Gordon Hintz of Oshkosh said Democrats would likely support many of Walker's proposals, but he criticized Walker for abruptly adopting longtime Democratic priorities. He said if Walker was sincere, he would also take additional federal money to expand the state Medicaid health program known as BadgerCare Plus, freeing up $203 million for the state next year. "He's a great politician, but a terrible executive," Hintz said of Walker, "I don't know that the governor deserves credit for putting out fires that he started."

Walker's stolen Democratic Party plan has a few Assembly written health care stripping hoops in it, to keep the number of insured down, like this one...:

GOP lawmakers took a health care bill that Democrats were attempting to pass and used an amendment to swap out the old bill with their own proposal. "Patients would need to avoid a gap in their health coverage" ... returning Wisconsin to a high-risk pool model, which was used to insure high-cost patients with difficult medical conditions before the passage of the federal Affordable Care Act.

Dumb Ron Johnson Admits GOP Market based Health Care Guarantee doesn't Work!!!

The GOP health care plan is actually worse than many of the experts predict because they continue to low ball premium and deductible increases. I remember how the market worked before the ACA in the individual market, and it was bad, real bad. Back around 2006, and with no health problems, my deductible was $10,500, imagine what it would be today.

Dumb Ron Johnson is Back: Paul Ryan wrongly conflates health care with a consumer product, so he can make a "free market" argument for reform. He's scamming us.

So in roars Dumb Ron Johnson comparing our bodies with "crashed" cars. But we don't keep cars our entire life, and cars can be junked...not our bodies. If it's true that guaranteeing coverage for the sick crashes as Johnson claims, than maybe that market model is wrong? That's why every other country uses a different model, some form of a universal care, and it works...no crashes:

Johnson: “We know why those premiums doubled. We’ve done something with our health care system that you would never think about doing, for example, with auto insurance, where you would require auto insurance companies to sell a policy to somebody after they crash their car.”

“States that have enacted guaranteed issue for preexisting conditions, it crashes their markets. It causes the markets to collapse. It causes premiums to skyrocket.”

So...let's go with that plan?



Rand Paul says he want to legalize "Inexpensive Insurance," basically Junk Policies: I heard one reporter say Paul is pushing "junksurance." Sure, you may be under-insured and go bankrupt, but Rand Paul is there to protect your freedom. Yeah?

Paul is apparently unaware of the role men play in women's pregnancies. So he's thinks women should pay the whole bill. "Social responsibility" and "for the greater good" are being replaced with the politics of resentment, where you can always ask, "why should I have to pay for someone else's problem."

Even Charles Krauthammer kind of makes the case for Universal Health Care.

Ah, where are the Democrats? After Paul Ryan's failed and convoluted health insurance failure that would see 24 million Americans lose coverage, why aren't Democrats making the most of this opportunity to push universal care. 

Why are Democrats are so bad at going on the offensive and making their case every time they get in front of a microphone? Seriously, it's so easy to do that even conservative columnist Charles Krauthammer made a convincing case for universal care in the U.S.. Check it out below:

But there is an ideological consideration that could ultimately determine the fate of any Obamacare replacement. Obamacare may turn out to be unworkable, indeed doomed, but it is having a profound effect on the zeitgeist: It is universalizing the idea of universal coverage.

Acceptance of its major premise — that no one be denied health care — is more widespread than ever. Even House Speaker Paul Ryan avers that “our goal is to give every American access to quality, affordable health care,” making universality an essential premise of his own reform. And look at how sensitive and defensive Republicans have been about the possibility of people losing coverage in any Obamacare repeal.

A broad national consensus is developing that health care is indeed a right. This is historically new. And it carries immense implications for the future. It suggests that we may be heading inexorably to a government-run, single-payer system. It’s what Barack Obama once admitted he would have preferred but didn’t think the country was ready for. It may be ready now.

As Obamacare continues to unravel, it won’t take much for Democrats to abandon that Rube Goldberg wreckage and go for the simplicity and the universality of Medicare-for-all. Republicans will have one last chance to try to persuade the country to remain with a market-based system, preferably one encompassing all the provisions that, for procedural reasons, had been left out of their latest proposal.

Don’t be surprised, however, if, in the end, single-payer wins out. Indeed, I wouldn’t be terribly surprised if Donald Trump, reading the zeitgeist, pulls the greatest 180 since Disraeli “dished the Whigs” in 1867 (by radically expanding the franchise) and joins the single-payer side.

Free Market Medicine: Hospitals to Prioritize, take Privately Insured over Medicare and Medicaid Patients.

TrumpCare/RyanCare is "free market" voodoo: The CBO analysis may have freaked Republicans out, but that bad news only scratching the surface. There are so many moving parts in health care, that it's like a game of whack-a-mole.

The GOP's "free market" voodoo gives insurers and hospitals unlimited control over 17.8 percent of the economy. With that much money on the line, what do you think will happen?

Profit over People: Hey, it's business:

Dr. John Noseworthy, the chief executive of the Mayo Clinic, recently told his employees that the prestigious health system will prioritize the care of privately insured patients over those on Medicare and Medicaid.

That's bad news for the massive number of baby boomers moving into Medicare.

That bold pronouncement reflects the growing unease among hospital executives who are watching profits shrink due to steady increases in the number of government-insured patients. Noseworthy said...

“We’re asking … if the patient has commercial insurance, or [if] they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so … we can be financially strong at the end of the year.” 

While we were concentrating on the huge number of people losing their insurance in the individual market, Medicare patients are getting pushed aside by hospitals as well:

“There is this thought that hospitals treat whoever comes to their door, but this is a statement that lays out what happens,” said Christine Spencer, a health economist at the University of Baltimore. “It’s a surprise to hear it out loud like that."

Hospital Power Play: This isn't a new concept either, and its created inflated insurance premiums in the past in regions where hospitals have monopoly power. 

The health system’s market power gives it the ability to charge more for its services and command high payments from commercial insurers, a clout it can’t wield with the federal government. So, in prioritizing those commercially insured patients, it is following the money.

According to Harold Miller, chief executive of the Center for Healthcare Quality and Payment Reform:

“It’s a very lucrative thing for them to do." While it makes sense from business perspective, it doesn’t help to solve the underlying problem of America’s sky-high medical costs. “True leadership would be to figure out how to deliver high-quality services at the lowest cost possible. If institutions are simply going to say, ‘I’m not going to serve patients unless I get paid more,’ that’s only contributing to the problem.”

While Republicans feign concern over the poor, and play them for saps by giving them a false sense of security with bare bones catastrophic junk insurance policies, hospitals are aiming for much higher:

The hunt for higher-paying patients plays out in all sorts of ways, experts said. A medical center may locate its satellite offices and target its advertising in wealthier suburbs. Hospitals might reduce emergency room services so they do not have to handle the chronic yet untreated issues — such as diabetes or high blood pressure — that regularly bring people without insurance to the hospital.

Regulation is another way of saying Protection: Word smith George Lakoff came up with this simple interpretation. Once I had a chance to absorb the concept, I immediately saw how it works for "free markets" and "social" programs.

In reality, government doesn't get out of the way in a free market system, it actually establishes regulations - or protections - that let businesses do things.  "Socialism" also provides regulation - protections - but for the public good. So which side do you want to protect more?    

Free Market Health Care Disaster now the Republican Rage...

Republicans automatically assume nothing will never need increased funding. Increasing taxes for that funding, no matter what, is not going to happen.

So getting rid of programs running on empty or coming up short is the answer. It's an odd reaction to life saving invaluable safety net "entitlements." It's what makes us a civilized society.

Virginia Republican Rep. Dave Brat in the interview below doesn't remember life before the ACA. People were dying due to their lack of affordable health care or preexisting conditions. Just as bad, small businesses were crushed out of existence by health care costs, and entrepreneurs were discouraged from going out on their own for lack of health care coverage.

Brat wants to go back, and dabble in the Milton Friedman experiment. Sure it could devastate the lives of hundreds of millions of Americans, but taxpayers are already paying for Brat's own health care, what's it to him?

Brat: "...the current system is collapsing on its own logic. So when you have a bad promise, and the other side has designed a system, and the cars in the ditch, and socialism didn't work, then the onus of the argument is all of a sudden on our free market guy."

Yup, because the free market doesn't work for health care.



Brat: "You have heart procedures here that are $150 grand, then in India are $15 grand.

Brat might be shocked to learn....

The health care system in India is universal. That being said, there is great discrepancy in the quality and coverage of medical treatment in India. Healthcare between states and rural and urban areas can be vastly different.

Brat also brags about Milton Friedman's free market solution, similar to what we're hearing from every other Republican loser, especially Paul Ryan. What these guys aren't telling you about Friedman's plan might help Americans buy health care. The negative income tax, a government check sent to income poor Americans so they can live a decent life, maybe even buy insurance. Big piece of the Friedman puzzle:

Silent no longer, Doctors and Major Medical Publications get behind Single Payer!!!

While the U.S. is now on the verge of instituting a fully privatized health care system based on profits and limiting corporate risks, doctors nationwide are speaking out:

In a dramatic show of physician support for making a decisive break with the private insurance model of financing medical care - 2,231 physicians called today for the creation of a publicly financed, single-payer national health program that would cover all Americans for all medically necessary care. The proposal was drafted by a blue-ribbon panel of 39 leading physicians. A 2008 survey of physicians found that 59 percent supported "legislation to establish national health insurance," up from 49 percent five years earlier.

Doctors are now on the side of universal health care, big time. Why? Check out the following statement from "Dr. Adam Gaffney, a Boston-based pulmonary disease and critical care specialist, lead author of a recent editorial and co-chair of the Working Group that produced their proposal:"

"Caring relationships are increasingly taking a back seat to the financial prerogatives of insurance firms, corporate providers, and Big Pharma. Our patients are suffering and our profession is being degraded and disfigured by these mercenary interests."

But with Paul Ryan's repeal and replace fiasco, we're going in the opposite direction, walking away from the following benefits actually supported by doctors:

Under the national health program (NHP) outlined by the physicians:

1. Patients could choose to go to any doctor and hospital. Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHP to cover all operating costs. 

2. Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics.

3. The program would be paid for by combining current sources of government health spending into a single fund with modest new taxes that would be fully offset by reductions in premiums and out-of-pocket spending. Co-pays and deductibles would be eliminated.

4. The single-payer program would save about $500 billion annually by eliminating the high overhead and profits of insurance firms, and the massive paperwork they inflict on hospitals and doctors.

5. The administrative savings of the streamlined system would fully offset the costs of covering the uninsured and upgraded coverage for everyone else, e.g. full coverage of prescription drugs, dental care and long-term care. Savings would also be redirected to currently underfunded health priorities, particularly public health.

6. The "single payer" would be in a strong position to negotiate lower prices for medications and other medical supplies, yielding additional savings and reining in costs.

This puts the people and doctors in the drivers seat. In an editorial supporting single payer....

Proposals floated by Republican leaders won't achieve President Trump's campaign promises of more coverage, better benefits, and lower costs, but a single-payer reform would, according to a commentary published today in Annals of Internal Medicine, one of the nation's most prestigious and widely cited medical journals.

In today's Annals commentary, Longtime health policy experts Drs. Steffie Woolhandler and David Himmelstein warn that the proposals would slash Medicaid spending for the poor, shift the ACA's subsidies from the near-poor to wealthier Americans, and replace Medicare with a voucher program, even as they would cut Medicare's funding and raise the program's eligibility age.

Point by point, single payer continues to save money and free people and businesses from crippling bills:

Single-payer reform could provide comprehensive first-dollar coverage to all Americans within the current budgetary envelope because of vast savings on health care bureaucracy and profits.

1. $504 billion annually on health care paperwork and profits, including $220 billion on insurance overhead

2. $150 billion in hospital billing and administration

3. $75 billion doctors' billing and paperwork. They estimate that an additional $113 billion could be saved each year by hard bargaining with drug companies over prices.

4. The savings would cover the cost of expanding insurance to the 26 million who remain uninsured despite the ACA, "plugging the gaps in existing coverage.

5. Abolishing copayments and deductibles.

6. Covering such services as dental and long-term care that many policies exclude."

The lead author of the commentary, Dr. Steffie Woolhandler, said: "We're wasting hundreds of billions of health care dollars on insurance paperwork and profits. Private insurers take more than 12 cents of every premium dollar for their overhead and profit, as compared to just over 2 cents in Medicare. Meanwhile, 26 million are still uninsured and millions more with coverage can't afford care.

Dr. David Himmelstein, the senior author, said, “Polls show that most Americans—including most people who want the ACA repealed, and even a strong minority of Republicans - want single-payer reform.

And doctors are crying out for such reform. The Annals of Internal Medicine is one of the most respected and traditional medical journals. Their willingness to publish a call for single payer signals that it's a mainstream idea in our profession."

Real Health: Big Pharma's Free Speech Rights; GOP opposes saving money on Medicare; Doctors Burning out on Insurance Paperwork-increasing Medical Errors!!!

Freeloading Republicans loves getting a taxpayer check, they just don't like to do anything to earn it. Health care privatization is their way to shift responsibility, so they can shrug their shoulders and say "don't blame us, that's the free market."

Starting with this report, I'll be featuring stories from Modern Healthcare, a great source of news that digs much deeper into the real and more complicated problems of health care than the simple repeal ObamaCare or not distraction. This a subscription service, so some of the links will be inaccessible.

 Republicans Oppose Saving Money on Medicare:

 Multiplesources confirmed that Republicans upset with what they say is overreach by the Center for Medicare and Medicaid Innovation, also known as CMMI … (and) could lead to (Republican) legislation intended to hinder the agency and slow its attempts to further the goal of paying providers for value rather than volume.

Here’s the key point given by Republicans that could easily be applied to their own free market gamble, a bad idea that not one industrialized country is using, and for good reason – it doesn’t work:

More than 170 House Republicans sent a letter to Adminstrator Andy Slavitt in September asking that the CMMI stop requiring mandatory participation in any payment models; “Medicare providers and their patients are blindly being forced into high-risk government-dictated reforms with unknown impacts. Any true medical experiment requires patients' consent. However, patients residing in an affected geographical area will have no choice about their participation.”

1^st Amendment gives Big Pharma “Free Speech” rights to Stuff Corporate Pockets? 

The Food and Drug Administration is considering dramatic changes to its drug marketing rules that threaten to make the problem of already out-of-control drug spending even worse … responding to the drug industry's demands for greater freedom to “promote” the off-label use of prescription drugs and to the courts' drift toward giving corporations unlimited freedom-of-speech rights.

“Off-label” refers to uses that have never received approval or scrutiny from the FDA's regulatory scientists (Doctors are allowed to prescribe off-label). The FDA is undertaking its “comprehensive review” now because of a string of recent court decisions saying the First Amendment gives industry sales representatives free rein to promote unproven uses to physicians. The agency may be betting that by weakening its current rules, it will forestall review by a U.S. Supreme Court that is moving rapidly to giving corporations the rights of individuals. But that's the wrong calculus for an agency that's supposed to ensure every drug is safe and efficacious. 

Private Health Care System is Burning Doctors Out of Business, Increasing Medical Errors:

Burnout, defined as physical and emotional exhaustion as a result of prolonged stress, has become shockingly prevalent among U.S. physicians. Doctors experiencing professional burnout not only put their own well-being at risk, but also that of their patients … studies have found that distressed healthcare providers make more mistakes on the job. Surgeons who feel burned out have a higher likelihood of reporting major medical errors, which are estimated to be the third-leading cause of death in the U.S. ahead of stroke and diabetes. Half of surveyed physicians believe that overwork, stress and fatigue among health professionals significantly contribute to medical errors.

In recent years, changes have caused the problem of burnout to worsen. Demographers project the Medicare-eligible population will more than double by 2060. Older people require more care.

A study published in July by the Mayo Clinic Proceedings explored the relationship between clerical tasks, the electronic practice environment and burnout. Doctors who used Electronic Health Records and computerized physician order entry (CPOE) had lower levels of satisfaction because of the amount of time spent on clerical tasks and reported higher rates of burnout. “There are several broad categories of contributors to physician burnout, including greater work hours and effort, poor work efficiency and support, and loss of meaning in work,” said Dr. Colin P. West at the Mayo Clinic, who co-authored the study. “Although the promise of the electronic medical record has been to allow more efficient, higher-quality care, often clerical tasks and electronic medical records negatively affect all of these contributors … leaving less opportunity to interact with patients. In short, we need the technology to support its users rather than the current norm of the users serving the technology.” The extra time required for these routine tasks often crosses the borders of the office into the physician's home, disrupting work-life balance and personal relationships. 

Warning: Free Market Health Care System will see Consolidation & Skyrocketing Premium Increases!!!

This whole health care debate about repealing the Affordable Care Act for private free market competition is a ruse to distract from the anti-competitive multi-layered problems and abuses private insurers and medical providers are using right now. 

It’s an early look at what will happen if Republicans turn health care into an unregulated private sector profit making machine. And since most people have employer provided health care, they don’t know any of this is happening.

Keep in mind, if medical errors were a disease, it would be the third major cause of death in the US..

Under that backdrop, check out what one market dominant hospital system is doing to not just shield themselves from lawsuits, but prevent businesses from negotiating away increased premiums. This is where hospital consolidation nationwide will take us. WPR: 

San Francisco Bay Area companies say Sutter Health, the largest medical system in Northern California, is strong-arming them into a contract that would help the hospital system secure its power over prices and potentially raise the cost of medical care for their employees in the future. Dozens of companies have received a letter, via their insurance administrators, asking them to waive their rights to sue Sutter. If they don't, a fact sheet says, the companies' employees who get care through Sutter's network of hospitals, doctors and medical services will no longer have access to discounted in-network prices.

"In both choices, Castlight and our employees lose," says Jennifer Chaloemtiarana, general counsel for Castlight Health, a tech company in San Francisco.

As an employer that pays its employees' medical claims, Castlight doesn't like the idea that it will never be able to challenge Sutter over its prices in open court … waiving that right would only help strengthen the power of Sutter's "already dominant" provider network.

Economists have long argued that Sutter uses this power to charge more for its services. Sutter's hospital prices are about 25 percent higher than other hospitals around the state, according to a recent study from the University of Southern California. Having a very strong, dominant provider system will reduce choice.

Wasn't "choice" the whole reason why we have to go to a privatized health care system? Guess that was wrong. 

We’re Right, Everybody Else is Wrong: It should come as no big surprise that Sutter Health arrogantly believes their critics are wrong, and all that fact-based research is biased:

"Recent academic studies have been one-sided and misrepresent the competitive environment of Northern California," said Bill Gleeson, vice president of communications for Sutter, adding that the studies "unjustly inflate the so-called market share of Sutter. There's competition all around." Gleeson says companies "can't accept deep discounts and make up their own rules."

Just another ugly wrinkle in the private insurance market that will only get worse if politicians let "free market" principles roll over the public welfare for money.

Walker gives Health Care Costs a shove Upward, blames ObamaCare.

Republicans may whine about health care costs skyrocketing under ObamaCare, but it's all just a show. Thanks to Scott Walker and his band of plundering pirates, ObamaCare will cost more and wither away just like they said it would.

The irony? Walker's anti-ObamaCare supporters are now buying junk policies. And you know what, some of them deserve it.

Citizen Action of Wisconsin:

Walker Administration Deliberately Rigging Health Insurance System to Raise Rates: Almost as many people enrolled in substandard “lemon” health plans in Wisconsin as buy individual coverage through Healthcare.gov.

We know this because of an inadvertent admission by Deputy Insurance Commissioner J.P. Wieske during a recent hearing, that...:  

"...a much larger number of Wisconsinites than previously believed are enrolled in substandard health plans which do not meet the standards of the Affordable Care Act (ACA)."

Those stubborn and not so "fiscally conservative" Walker backers decided to "keep the plan they already had." 

In the hearing Wieske testified that 203,000 Wisconsinites are covered by so-called “transitional plans,” often referred to as “grandmothered” plans. Currently 239,034 Wisconsin health consumers are enrolled in individual coverage on Healthcare.gov. This means the ACA marketplaces in Wisconsin would be much larger if these transitional plans were prohibited.

People on these grandmothered plans...

...tend to be healthier, because the insurance corporations were still permitted at the time to discriminate against people with health conditions. Wisconsin exercised the option to continue these plans, while Minnesota and many other states working to improve health care access banned them.

Why keep the old plans? To slowly destroy ObamaCare by keeping half the people off the exchanges:

1. Substandard “lemon” plans increase prices in the ACA marketplace by skimming healthier people.This deprives healthier individuals from the ACA marketplace, leaving the remaining population sicker and costlier, and raising rates.

2. Even when they are cheaper, substandard “lemon” plans can be dangerous for health consumers when they face a major injury or illness. These plans often have gaps in coverage or extremely high cost sharing ... raising premiums by as much as 10 percent and decreasing enrollment” (Rand Corporation). “Integrating these underwritten members into the ACA pool is expected to improve the health status of the market as a whole, which could lower the relative cost of coverage on average.” (Milliman Actuaries)

So there you have it. And we keep electing people who hate government so much they'll do anything to make it worse:

“It is hard to escape the conclusion that the Walker Administration is deliberately trying to destabilize the Affordable Care Act by allowing insurance companies to skim healthier consumers,” said Robert Kraig, Executive Director of Citizen Action of Wisconsin. “The impact of this policy is to rig the health care system against Wisconsin families ... The only party who benefits from the continuation of lemon health plans is the insurance industry, which is allowed to continue to profit by separating the healthy from people with health conditions.

Clinton Health Care Plan adds 9.1 Million, Trump cuts 20 Million People off, meaning they can't keep their Insurance or Doctor.

The following story isn't that surprising, because other reports have said pretty much the same thing, but it does add to the growing list of reasons why Trump's health care and tax plan would destroy the country. 

While other articles put Trump’s disastrous health care plan first - because it is that horrific - I'm going to focused on Clinton’s better plan, right out of the gate. NBC News:  

The Clinton proposal includes a new tax credit for deductibles and copayments not covered by insurance, a richer formula for health law subsidies, a fix for the law's "family glitch" that can deny subsidies to some dependents, and a new government-sponsored "public option" health plan.

Taken together, the analysis estimated that Clinton's proposals would reduce the number of uninsured people in 2018 to 15.8 million, which translates to a gain of 9.1 million people with coverage. Not included were Clinton's idea for allowing middle-aged adults to buy into Medicare and her plan to convince more states to expand Medicaid.

Great plan. Now let’s look at Trump’s decidedly free market model that’ll drop 20 million people from coverage…I guess that would mean a lot of Americans wouldn’t be able to keep their insurance plans or doctor, right? 

According to the Commonwealth Fund study released Friday, Donald Trump would cause about 20 million to lose coverage while Clinton would provide an additional 9 million people.

One worrisome finding is that the number of uninsured people in fair or poor health could triple under Trump. When uninsured people wind up in the hospital, the cost of their treatment gets shifted to others, including state and federal taxpayers.

The study panned one of Trump's main ideas: allowing insurers to sell private policies across state lines. Insurers would cherry-pick the healthiest customers and steer them to skimpy plans … the overall conclusion seems to be on target ... "You could quibble about some of the modeling, but directionally I think it's right," said economist Douglas Holtz-Eakin, president of the American Action Forum, a center-right public policy center.

The study estimated that Trump's repeal of "Obamacare" would increase the number of uninsured people from 24.9 million to 44.6 million in 2018. The tax deduction and interstate health insurance sales would help some stay covered, but the Medicaid block grant would make even more people uninsured. The result would be an estimated 45.1 million uninsured people in 2018 under Trump - an increase of 20.2 million, reversing the coverage gains under Obama.

Trump Tax Plan adds Trillions to Debt: And for those who like Trump because he'll shake things up politically in Washington:

Recent analysis that delved into the candidates' tax proposals, by the nonpartisan Committee for a Responsible Federal Budget, found that Trump's latest tax proposals would increase federal debt by $5.3 trillion over the next decade, compared with $200 billion if Clinton's ideas were enacted. 

Imagine how that’ll shake things up, debating what to cut next. 

Dumb Ron Johnson: "freedom and limited government” = letting businesses deny insurance to employees with Cancer!!!

I thought Republicans were cruel when 1. they tried to maximize insurance company profits off of sick people by dumping them into the free market; 2. put susceptible seniors at the mercy of insurer tricks and scams; and 3. blocked all kinds of health care treatments based on someone else's "conscience," not to mention repealing ObamaCare.

They were bound to step over that line someday, but who would they get to take that leap?

Enter Dumb Ron Johnson. He values business over "we the people," the very voters he's supposed to represent, protect, and be the advocate for.

In making his argument, Johnson quickly eliminated the more liberal sounding "life" and "pursuit of happiness" points that would negate any Declaration of Independence promise:

SCOTT KEYES: I know Richard Murdock had said even though businesses should give people, for instance, with cancer, health coverage, they shouldn’t be legally required by the federal government.

JOHNSON: They shouldn’t. Listen, our rights are life, liberty, and the pursuit of happiness. And when we start expanding beyond that realm, when you create a right for somebody, you create an obligation for somebody else, and then you’re taking away that person’s right. And that maybe doesn’t seem all that great, but it’s just true. Our nation was based on the foundation of freedom and limited government.

Just the idea that a person would be allowed to die just to save a business money and promote the tea party cartoon version of "freedom and limited government" is so...grotesque:



Here's one trolls reaction to my "incoherent" common sense humane point. He not surprisingly supports employers refusing health care coverage for anyone with a preexisting condition. Of course, he will never need health care...another ER freeloader.

I wonder too, what right is Johnson talking about, I didn't see it there in the Constitution. A better example: When someones religious belief interferes with my own rights and freedoms...oh, that different?

Competition on ObamaCare exchanges worked!!! Lowered premiums!!! Now Insures want Out Due to Lower Profits!!!

Republicans think you forgot how our old health care system, before “ObamaCare,” failed miserably.

Who the hell is nostalgic for the days when insurers dropped people with pre-existing conditions, jacked premiums and deductibles up to unaffordable levels, and allowed insurers who cherry pick the healthiest Americans?

Since when do we rank health care by how much insurers make?

Hello, treating the sick and dying…remember that?

Now see how Forbe’s packages the Affordable Care Act as a failure because it cut insurance company profits, while saving you and me money. It should be a shock to your sense of humanity:

The story is similar for other insurers. Many have decided to abandon markets they have long served. That’s left people fewer options for coverage. And with less competition on the exchanges, the plans that remain have more freedom to hike premiums. Obamacare’s ongoing dysfunction is bad enough. But the looming collapse of its exchanges is prompting calls for even more government involvement in health care — even a single-payer system.

Competition Worked, Lowered Prices - now Insurers Want Out: Flipping market competition on its head, suddenly lower prices are bad...for them? Think about that; competition made insurers cut their premiums, which is now making them drop out of the exchange. If anything, the ObamaCare exchanges worked too well.

Forbe’s also wants you to think the ACA is “government” health care, when in fact it’s just a mall for private insurers:

It takes a special kind of reasoning to respond to the spectacular failure of government that is Obamacare by calling for, well, even more government.

Their Loss is Our Gain: Think of the next statement as money we saved shopping on the exchanges, and not money insurers “lost.”

Health insurance companies lost as much as 11 percent on their exchange plans last year. That’s more than double the amount they lost during the exchanges’ first year.

The following anti-competition group of insurers is part of a rogue’s gallery of blood thirsty profiteers, salivating for a Paul Ryan style plan of junk policies offering a la carte services (what you can afford) and loop holes you could drive a Mack truck through (small print legalese):

Insurers have responded by heading for the exits. UnitedHealth will now only sell health plans in three states. Humana abandoned several markets after posting a 46 percent drop in earnings. Premera Blue Cross will leave Oregon and a dozen counties in Washington State.

Want competition to work, stay away from these ghouls.

Promise? Not Quite: My own brother is pretty well off and told me how angry he was that he didn't at least get some kind of deal under the exchanges. I agreed, upper middle class folks should get something, but it wasn't like he'd go broke paying his own way. I know for a fact he would never go without coverage. Which brings me to the articles final statement.

These subsidies don’t apply to millions of middle-class people. To afford premiums, many must cut other parts of their household budget — or go uninsured.

The Obama administration promised that this wouldn’t happen. The White House said that Obamacare would “curb excessive premium growth for . . . millions of Americans.” It said that ... creating online exchanges would yield a marketplace where insurers competed on price and quality. But many Americans have not benefited. One in two disapproves of the law.

"...creating online exchanges would yield a marketplace where insurers competed on price and quality" and it worked, lowering prices and hurting insurance company profits. Cry me a river.

Walker out to prove rising health care Obama's fault, not the insurers jacked up prices.

Scott Walker’s plan to raise health care insurance prices in Wisconsin is working. Why would he do that? To pour more money into for profit insurers pockets, and to make “ObamaCare” look like a failure. 

The fact is, the outrageous cost for medical services by three of the biggest insurers in the state raised everyone's premium.

And don't forget about the state insurance commissions hands off approach to premium increases on the exchange. Walker voters, I'm guessing, don't mind handing their property tax savings over to the insurance industry, as long as it supports a very costly "free market" system. JS-Guy Boulton:

Claims data for three of the country's largest health insurers, (UnitedHealthcare, Humana and Aetna) including two of the largest in southeastern Wisconsin, rank the state as having the second-highest medical prices in the country, behind only Alaska.

A study by the Health Care Cost Institute, a nonprofit organization created to make claims data from health insurers available to researchers, found that prices for 235 common medical services grouped as "care bundles," ranging from basic tests to back surgery, were on average 81% higher in Wisconsin than the national average.

The supposed "best health care system in the world," still inaccessible to millions of Americans, continues to pick our pockets...because they can in the private sector. After checking out the stat below, you have to wonder why every Republican continues to make the false claim that moving to a single payer system won't save money:

The United States spends 50% more on health care than any other developed country — an average of $9,523 a person, or $38,092 for a family of four in 2014. And health insurance is expensive because health care is expensive.

The corporate response from the health care lobbyists in the state was laughable, if not a tad bit insulting. They claimed the report wasn't fair because the 3 biggest insurers weren't major players in other parts of the state, so...?

"The fact that the three insurers that provided data to the HCCI are not major players in most markets around the state makes this study misleading to readers, and largely irrelevant in Wisconsin," Brian Potter, senior vice president of the Wisconsin Hospital Association, said in a statement.

But UnitedHealthcare had 54% of the Milwaukee market, 49% of the Green Bay market and 37% of the Appleton market in 2013, according to a study by the American Medical Association.

The states industry lobbyist are telling us the same thing they said after the GAO released their study last year. Will we ever really know if we're paying too much in Wisconsin? No. Are we really that happy about cost of health care costs? We must be:

The same contention — that the claims database is not representative of the state — also was raised about a study by the Government Accountability Office released last year that found that Milwaukee and Madison were among the seven most expensive metropolitan areas in the country for three common procedures.

Further, even if the claims data used in the recent study by the Health Care Cost Institute is not representative of prices in some markets, UnitedHealthcare, Humana and Aetna still are paying the prices — and those prices are much higher than the national average.

Here's the sad truth about treating health care like a consumer product, like a market product:

If nothing else, the wide variation in prices strongly suggests a market that isn't working like other markets.

Government health programs, such as Medicare and Medicaid, set the prices they will pay.

The Republican argument against the Affordable Care Act has been successful because most people know little about it, and because they get coverage through their employer, which shields them from the actual cost:

But the U.S. health care system relies on the market to set prices paid by commercial health plans. It is a market in which the cost is largely hidden from the consumer — the patient — because medical bills are paid by health insurers and employers once someone hits his or her deductible and maximum out-of-pocket expenses. The result is that most patients are indifferent to the cost. 

And having gone through a futile attempt myself to get a hospital to tell me the actual price of their treatment, because prices vary depending on what insurer their working with (add to that a different price for cash), this might be the best argument against a market based system:

Getting information on prices also can be difficult. Even when insurers make prices available to the people in their health plans, few make use of the information.

When you're sick, injured or unconscious, how can anyone make the kind of choices necessary for the healthiest outcome? Who wants to burden relatives, even if you're lucky enough to have a few? The article wrapped up with this:

Employers have been reluctant to embrace health plans designed to encourage people to get care from doctors and hospitals that provide quality care at a lower cost.

For instance, few employers have moved to health plans based on so-called reference pricing or on tiers. A health plan based on reference pricing pays a set amount for certain medical services, ranging from MRIs to colonoscopies to back surgeries. People still are free to get care from anyone in a network. But they must pay the cost above the reference price.

Health plans tied to tiered networks give people an incentive, such as waiving the deductible, when they get care from hospitals and doctors that provide quality care at a lower cost. "Now the question is how do we fix health care. We know it is too expensive."

Having had cataract removal, the chart below is even more interesting to me. The U.S. average represents what I paid directly to the doctor and surgery center, bypassing my insurer and the $7,000 deductible. Yes, it was cheaper to pay directly than use the deductible and insurer. So is the the free market insurance model bad. Yes, and that's where Republicans want to take us:

 

Public Health the first to go under Republican Governors.

Anti-government Republican governors are killing us with an agenda that’s only just starting to rev up.

The evidence in piling up dangerously fast; Scott Walker had let the Lincoln Hills youth prison reel out of control before acting and is doing the same for water pollution and algae blooms growth, Gov. Rick Snyder knowingly let Flint Michigan residence drink high concentrations of lead in water, and now Gov. Rick Scott in Florida did away with their statewide standards for children’s heart surgery.

There are two jaw dropping takeaways in this tragic Florida story; The 38-year-old administrative standards were dropped because they were never officially passed into law (the hospital objecting to the standards donated lots of money to Scott), and a judge ruled in favor of the state. Here’s the outrageous "reasoning" from Florida Administrative Law Judge John Van Laningham said:

(The notion that hospitals) "would suddenly stop providing quality pediatric cardiac services immediately upon repeal of the Standards rests on pure speculation -- and is a little insulting to the health care professionals who personally deliver those services. Many people derive personal satisfaction from doing a job well, whether the job is, e.g., painting a house or performing open-heart surgery, and they strive to deliver a quality product, not in obedience to the superintending guidance of the administrative state, but because they want to."

By the way, that is exactly the same logic lawmakers used for Wall Street, resulting in banks lying to investors, who then lost everything in the Great Recession. Alan Greenspan admitted as much.

This wasn't the first bad decision from Judge John Van Laningham:

Van Laningham is no stranger to controversial opinions. In 2014, he said a doctor accused of beating and handcuffing a patient during a yearlong sexual relationship should be allowed to continue practicing medicine.

The offending hospital, Tenent Healthcare's St. Mary's, finally stopped performing child surgeries, but not after complaining and...

...At least nine babies died after heart surgeries there over the course of 3½ years, from the end of 2011 to June 2015.

"I've seen botched surgeries. I've seen cases where they did the wrong surgery," says Dr. Edward Bove. 

Dr. Joseph Forbess, director of cardiac surgery at Children's Medical Center Dallas, says he's seen the same. "By the time they send them to us, the child is dying," he says. "It's very difficult for us because you know you could probably have done it better.

St. Mary's and the state were unmoved:

Babies continued to die at St. Mary's. And, after CNN's investigation, the state rushed to the hospital's defense. Within days, Department of Health spokeswoman Tiffany Cowie told reporters that state data showed St. Mary's mortality rate wasn't nearly as high as CNN had found.

But Cowie didn't mention a crucial detail: The state data she referred to didn't take into account half of the babies' deaths. Those babies had surgery at St. Mary's, but when their health spiraled downward, they were transferred to other hospitals. Those hospitals could not save them. The database Florida uses did not include those deaths, according to experts who manage that database. 

Even though the state defended St. Mary's mortality rate, in August the hospital closed its pediatric heart surgery program and the CEO resigned.

If you have the time check out the additional summary below and the links. It's horrific. Where are all those pro-life groups when you need them:

CNN: Heart doctors outraged Florida dumps hospital standards after big gifts to GOP: The state of Florida is putting thousands of children with heart defects at risk, a group of cardiac doctors say, because of a change in policy that came after Tenet Healthcare contributed $200,000 to Florida Republicans.

In a widely publicized investigation in June, CNN revealed that a program at a Tenet hospital in Florida had failed to live up to state quality standards for children's heart surgery. Less than two months later, the state decided to get rid of those standards. That decision came after the giant for-profit hospital chain made contributions to Republican Gov. Rick Scott and his party that dwarfed those the company made to candidates or parties in other states.

Doctors from around the state say the decision came right from the governor's office. The doctors argued that the quality standards have been in place since 1977, saved children's lives and had become a model for other states.

When the standards were dropped anyway, the parents of four children with heart defects took the state to court. Florida's Department of Health said the quality standards had to go because the Legislature had never given permission to put them in place. The standards have been in place and uncontested for 38 years.

"Our number one priority is the health of all Floridians, especially children," Department of Health spokeswoman Mara Gambineri said in an email to CNN ... "the department's authority is limited to those functions statutorily delegated by the Legislature." 

In July, the state announced it would repeal hospital standards for children's heart surgery. In December, a judge ruled in the state's favor and said the standards for pediatric heart hospitals could be taken off the books. Florida Administrative Law Judge John Van Laningham didn't base his ruling on the state's argument that it lacked the legislative authority to enact the standards. Instead, he said the parents who took the state to court had failed to prove that getting rid of the standards would lower the quality of their children's care.

Now, the cardiac doctors are considering whether to appeal the judge's decision.

"BernieCare" single payer vs Republican Rube Goldberg free market based health care model.

It's interesting to note that the government already "pays about half of the nation's health care bills." That said, Sen. Bernie Sanders wants to go all the way, with an all inclusive government run system.

Real Freedom and liberty: It's easy to sell this too, which begs the question why Democrats don't run with this; No more surprise bills in the mail, no more paperwork, every doctor is your doctor, every hospital is your hospital, and dental is finally included. Say goodbye to outrageously high long term care insurance policies. A yearly premium for someone making $40,000 equals about one monthly premium in our current system.

Bernie's Plan - Breaking it down to the basics:

(It puts) the $3.2 trillion-a-year U.S. health care system in the hands of the federal government, with states acting as administrative subcontractors.

1. Eliminate such things as insurance premiums, deductibles and copays. In their place would be taxes ... a new 2.2 percent "health care income tax," with higher rates for upper-income earners.

2. Sanders would incorporate Medicare and Medicaid into the new system, promising that patients would have no gaps in coverage.

3. You could go to the doctor or spend two weeks in the hospital and not worry about getting a bill.

4. No insurance premiums, deductibles, cost-sharing or copays, even for brand-name medications. Gone would be worries about being penalized for seeing an out-of-network doctor.

5. Long-term care would be covered, whether in a nursing facility or one's own home.

6. Most dental care would be covered, too.

7. For drugmakers, the single-payer system means government-set prices, a reality they must endure in other countries.

WHAT ABOUT INSURERS? Economic changes, new technologies, and globalization have disrupted many industries. People in the United States have learned to live with fast-paced change, even if they don't like it. Under Sanders' plan insurers would be relegated to selling supplemental coverage for services not covered under the single-payer plan. States could hire them to help administer coverage. But hundreds of thousands of jobs would disappear. Billions of dollars in shareholder equity would evaporate. Sanders has proposed a transition plan for workers displaced by the conversion to single-payer. That plan, too, would have to be paid for with taxes.

1. Administrative savings would come from doing away with layers of insurance company bureaucracy. Those would be offset somewhat because the government bureaucracy would grow.

2. As with Medicaid, states would be expected to cover part of the cost of new system. How much remains to be determined.

Crazy Rube Goldberg Ideas from the Right: Adding to the convoluted GOP list of plans is Dr. Ben Carson, who should know better. Take his plan for Medicare; we already know a seniors ability to manage finances drops dramatically as they get older, so forcing them to shop for health coverage is insane:

Medicare itself would be restructured, providing beneficiaries with a fixed payment for a private insurance plan of their choice. His proposal relies largely on tax-sheltered personal accounts, 'Health Empowerment Accounts," opened for every citizen at birth, to promote patient choice, and foster competition among private insurers ... The tax-sheltered accounts would be paired with high-deductible major medical insurance. Routine costs could be covered from the accounts, which would build up balances with time. Carson would also gradually increase the Medicare eligibility age to 70 from the current age of 65.  

I included Carson's Medicare plan because it's similar to the "free market" GOP vision for health care in general, and the "market oriented" systems in Singapore and Switzerland, which is god awful. Singapore takes a whopping 20% out of your paycheck to pay for in patient health care, but not outpatient, which you pay for on your own. Ouch!

Remember, Bernie Sanders' plan takes only 2.2% out of your paycheck.

You'll notice "cost-efficiency" touted below, but that applies to the government, not to us. We get soaked, leaving our economic security up for grabs. It's a convoluted nightmare. The Atlantic:

Socialized medicine saves money, relative to the American system. Switzerland and Singapore  provide powerful examples of how market-oriented health care systems are more cost-efficient than socialized ones.

In Switzerland, there are no government-run insurance plans, no "public options" ... the Swiss get subsidies, much like "premium support" proposals for Medicare reform or the ACA exchanges, from which Swiss citizens buy health care from private insurers. The subsidies are scaled up or down based on income. Switzerland is high on the league tables in terms of government health spending  ... combining high-deductible insurance with health savings accounts for routine expenditures.

THE SINGAPORE MIRACLE?: Singapore has the most market-oriented system in the world. Singapore's comparable (if not higher) health outcomes, and spends an absurdly low amount on health care relative to the West. The key to the Singapore system is mandatory health savings accounts ... like our Social Security system, Singapore takes mandatory deductions from workers' paychecks--around 20 percent of wages--and deposits them into health savings accounts called Medisave. Medisave accounts are used mostly for inpatient expenses, but ... Singaporeans are expected to pay most of their outpatient expenses with non-Medisave cash.

On top of Medisave, Singapore has a government-run catastrophic insurance program called Medishield. Singaporeans can opt out of that plan and buy private catastrophic insurance. Premiums for Medishield can be paid for using the Medisave health savings accounts.

Then there is Medifund, a safety-net program for the bottom 10 percent of income earners, and Eldershield, a private insurance program for long-term care for those with old age-related disabilities. On top of these government-sponsored programs, Singaporeans can buy supplemental insurance for things like outpatient expenses.

It incorporates the central idea behind free-market health care: that health-care spending is most efficient when that spending is executed by individual patients, rather than third parties. It's easy to waste other people's money. But if that money is your own, you are going to try your best to spend it wisely.

No, it's actually called self rationing, which is never a good idea:

Singapore, of course, isn't a democracy--which allows the government to install sweeping changes that wouldn't be realistic here.

The Swiss and Singaporean models wouldn't be perfect models for America...

Check out this ridiculously biased Cato Institute report on universal care vs market based: 2008 paper by Michael Tanner.) The report points to 4 arguments against single payer, and two of them are the same; long lines and rationing. Really, we don't have waiting periods here to see a specialist, and people that can't pay or are dropped for preexisting conditions isn't rationing?