Vermont aims to lead in single payer health system

[Sing]

http://sanders.senate.gov/newsroom/news/?id=32d1eba1-fea7-4d17-b3e9-9f2a5dc64a73

News in the hopeful category. It hasn't happened yet but with a fully Democratic administration in VT, could possibly succeed if the waivers can be obtained. If not VT already has and is moving towards an increasingly inclusive health care system.

 

[*GG*]

I don't see this as good news, reminds me of GIGO, garbage in, garbage out!

How is single payer going to help train Drs, and provide for much needed research?!

GG

 

[Sing]

As my signature states, "Never approach a bull from the front, a horse from the rear or a fool from any direction."

 

[Sing]

Look, GG, I don't want to fight with you. Calling an expansion of health care coverage "garbage" is aggressive, in my book. Not only that, but you have missed the point that I wished to make, which is that for those of us without any health care or resources for medical care--and there are quite a few with this illness--VT is a place some of us might wish to keep an eye on, where we might receive care in the future. And if this does come to pass and serves as a model for some of the other states, further access to health care will be possible. We have many medical needs, not just the need for good research into ME/CFS and specialist care, which it is true that we also need. We definitely need great research and specialists, and that has been the major part of our political focus here on the forum. Yet we need all the other medical care as well. And with limited or no ability to work, with exhausted resources, an expansion of services ought to offer hope in this respect.

 

[WillowJ]

single-payer system is unlikely to help those that need the help the most, simply because they have to compete with everyone else for the same resources. also because people are then unable to choose among options but have to just put up with whatever is chosen for them (think NHS).

in my view, and I think the research is with me, it's much better to create targeted programs for vulnerable populations and then actually fund those (unlike Medicaid which isn't properly funded). Preferably done as a voucher-type system like the food assistance program so people can choose their own insurer, doctor, etc.

For extensive research, see The Heritage Foundation

example posts:

Handling pre-existing conditions:
http://blog.heritage.org/2010/09/22/the-right-way-to-limit-pre-existing-condition-exclusions/

http://www.heritage.org/research/projects/the-case-against-obamacare (several of these items are applicable to single payer coverage in general)

 

[Sing]

Hi WillowJ,

In the single payer system, patients can pick their own doctors; hospitalization and prescription costs are covered. There may be small co-pays or a small premium each month if it works like the state Medicaid program--for those who are unemployed or low income--or there may be a small payroll tax for those who are employed. But the government isn't dictating types of care or doctors, etc. That does happen in some systems, as we know! Apparently there are many varieties of state sponsored medical care. The single payer idea is a common pool of money to pay for the care that the doctor (of choice) decides on--just to clarify--the government isn't dictating the care.

 

[Sing]

WillowJ,

Just to add to what I wrote: the single payer system is just a common pool of money which is used to pay for a certain set of medical problems. It isn't used to pay for elective procedures or experimental ones, for example. Procedures and treatments would usually need to be accepted as standard medical care first. So, for example, the tests for XMRV wouldn't be covered yet, but when they are standard and the link is scientifically established and agreed upon to disease, including ME-CFS, then that would be covered.

You are right that a single payer system would not cover everything, but only those things within the "standard of care" doctors follow. As ME-CFS is hardly established as a disease with known features, standard testing and treatment, some of what we would need is left out, but not all. For example, orthostatic intolerance, or low endocrine functioning or sleep disorders, etc.--the individual symptoms--could be treated and covered; however, their link with ME-CFS would not be "understood" unless the particular doctor had educated him/her self about ME-CFS.

I have the state Medicaid program and get a lot of good help but am always trying to educate, to communicate about ME-CFS and make the links to it. I have to lead my own care, in some respects--which is not as good as having an informed medical specialist! But I do get help for the particular symptoms, and I also get help for any other medical problems which arise--accidents, arthritic joints, etc.

 

[*GG*]

Look, GG, I don't want to fight with you. Calling an expansion of health care coverage "garbage" is aggressive, in my book. Not only that, but you have missed the point that I wished to make, which is that for those of us without any health care or resources for medical care--and there are quite a few with this illness--VT is a place some of us might wish to keep an eye on, where we might receive care in the future. And if this does come to pass and serves as a model for some of the other states, further access to health care will be possible. We have many medical needs, not just the need for good research into ME/CFS and specialist care, which it is true that we also need. We definitely need great research and specialists, and that has been the major part of our political focus here on the forum. Yet we need all the other medical care as well. And with limited or no ability to work, with exhausted resources, an expansion of services ought to offer hope in this respect.

I am not looking to fight either, like to try to use my energy wisely. I was just trying to suggest what WillowJ seems to be saying, sorry if I came across as harsh. I just don't want people to get there hope up on this as "what is going to save them". I don't want to dash hopes either, just trying to be realistic.

GG

 

[WillowJ]

I'm glad you're getting help from Medicaid. Many people with Medicaid can't find a doctor who can take them on, because Medicaid doesn't currently pay the doctors and clinics enough to recompense them for the amount they spend on testing and supplies, much less time.

 

[Sing]

Thanks, GG, apology accepted. Yeah, single or Medicare/Medicaid for all won't save us, but it does provide something.

WillowJ, I live in a rural/small towns kind of area and haven't had trouble finding a doctor, or specialist who accepts Medicaid except for one good primary doctor I had in the past who took no insurance at all. She didn't like the games, the overhead, etc. and wanted to be able to spend the time with patients that they needed. Unfortunately, after a while she could no longer afford to stay in business, and stopped practicing.

However, the problem I have is the problem most of us have--most doctors I encounter know little about ME-CFS. I have noticed that their attitude has changed to a more accepting, respectful one than it used to be--which is a break--but they still don't know how it works. So, my collaboration with doctors is not so easy, efficient and focussed as I wish it were.

 

[toddm1960]

If anyone can explain to me the value insurance companies add to the medical system, I'd be glad to stay in our current system. 50 million people in this country are without any health care, anything is better than nothing.

 

[Sing]

I think once upon a time they served the good purpose of pooling funds to be doled out when someone had a medical need they had agreed to cover. But as time went on they have leveraged more and more of the money into 'adminstrative costs", big salaries at the top, etc. and less and less for payouts. Their goal was profit, and of course, staying in business. A single payer system admiinstered by the govt like Medicare or Medicaid has much much lower administrative costs and a different goal: meeting the health needs of those covered, to the agreed upon extent, without tricks or games. I could go on. We all could.

When I had a regular insurance policy, nearly half the time there would be an error in terms of what they would cover, every time in their favor! It would take me hours to follow up with phone calls etc. to straighten it out. Their practices on "pre-existing conditions" of which there are nearly always some or something they can discover, and how they dump people off policies once they get sick, seem unconscionable. Now, with decreasing cognitive abilities, energy and no tolerance for these games, I have no use for the private insurance business. They are middlemen who are no longer necessary--in fact, who are in the way. IMO

 

[*GG*]

If anyone can explain to me the value insurance companies add to the medical system, I'd be glad to stay in our current system. 50 million people in this country are without any health care, anything is better than nothing.

It's the lesser of 2 evils for me. Do you really trust the Gov't which has MASSIVELY mishandled ME/CFS?

GG

 

[Sing]

My general understanding about the mishandling of ME-CFS is that this lies at the feet of the CDC and the NIH, govt institutions for sure. They has been influenced by big players like the insurance companies who are interested in limiting their payouts, and the pharmaceutical companies who want to make a lot of money on new drugs for widespread, common ailments, and then cultural influences too.

Cultural influences include sexism--illnesses regarded as women's illnesses get less funding and attention than those of men, for example, or soldiers who come back from a war with complaints and problems may be seen as unmanly, unwarriorlike. Illnesses that affect minorities such as Blacks or gay people also go to the bottom of the list. Ailments people suffer from chronically get less attention than those that people die from--there is another major consideration in what gets the money. So the way it comes out is that the things white men die from, or could die from, get the most funding. (This is why linking the danger of XMRV to aggressive prostate cancer is so helpful for gaining scientific attention and funding.)

So, whether or not a branch of govt also functions as the insurance carrier--still a more straightforward, economical and efficient way, in my view, than if private insurance companies do--there is still the matter of the above--the politics around what gets research attention and funding. Removing the insurance companies from the mix of power players could remove one barrier to studying a disease which is complex and costly. But, on the other hand, govts in other countries where there is a NHS, haven't shown themselves eager to finance such a thing either.

 

[zoe.a.m.]

My experience from having grown up and gone to college in VT is that they are always ahead of the curve and demand care and coverage that I have not experienced living in other states. Until I left VT, I was never without health care and prescription coverage, and these were practitioners of my choosing. I think it's important to separate all of the issues surrounding educating physicians and health care workers about ME/CFS and a single-payer-type system. It is reasonable to consider that if doctors do not have to spend their time, energy, and staff's time constantly dealing with insurance approval and claims, that research and continued education can become a much larger priority. There are many things that have to happen for education to become available for physicians...really, but let's at least give a chance to ways of managing the health care system that allow more time for patients if nothing else.

Living in WA state now, state-supported health care can be a many-year wait and sometimes it's simply impossible to get on the wait list--it's closed. Doctors are constantly changing what insurance they will accept and it's common for anything not hospital run to reject VA, medicaid, medicare, etc., that keeps the focus on who will even be allowed in the door--not on the patient, and certainly not on the nuance of their condition.

There is nothing wrong with taking the burden of the insurance system off of providers. I personally don't believe that, just because someone wants to go to medical school and become an MD or PA or ARNP, etc., they should also be willing or interested in running a business, and certainly not running their office to help for-profit insurance companies. It simply doesn't make sense. If insurance companies want to pay individuals to work in medical offices to handle their business so that the practitioners may focus on patient care, then I may change my opinion. At this point--and as someone who has worked behind the desk at a doctor's office--more of the day is spent dealing with claims and denials and asks than anything else. The more time that physicians and professionals have to focus on education can only mean better quality of care which brings with it new requirements about needing to treat all illnesses in the best ways possible. I understand there is always fear in terms of what it means to have someone else determine what is "best," but if VT is the example to follow, it was (hopefully still is) up to your chosen doctor to decide what course of treatment is necessary--and it's up to the patient to communicate what they want and need just as it is in any doctor/patient relationship. VT does have room to improve in allowing for complementary treatments however, and I do see this as necessary with an illness such as ME/CFS. Hopefully this is just a matter of time...

If we are going to be pro education for practitioners, something has to give, and it might as well be the red tape imo.