With the cost of health care rising and the ranks of the medically uninsured growing the single payer idea is back again. I kind of like the simplicity. Everybody is covered. The government is sole insurer, at least for basic care, free choice of doctors, private physicians, economies of scale with no cost for advertising - Medicare for everybody.

What do other folks think? Is single payer or some variation a good idea? Perhaps somebody has a radical alternative or just wants to tweak the present evolved combination of public and private. Give me your thoughts.

Gore's single payer idea

There are doctors who don't take insurance or Medicare because insurance doesn't pay the doctors enough for them to stay around. Let's say Doctor A is a great doctor and Doctor B is an okay doctor who can't do a very good job because of patient load. Doctor A's fee is $125 and Doctor B's fee is $100. You can go to doctor A or B for free, who do you want to go to? Well, Mr. G man says a doctor should charge $75 per visit to save his money. Well, it looks like doctor A is gone because you don't want to pay $50 out of pocket to see your free doctor. Doctor B already has a big patient load and now needs to take on doctor A's patients at $75. That just makes doctor B even worse.

Ranciduncle, I presume under this single payer system everyone would be covered and everyone, if they could, would be paying in; so the doctors are dealing essentially with one insurer, the government. They could operate outside the system and just take cash but how many could sustain themselves on that basis? I think doctor A and B would probably simply be part of a broad medical lobby that would insure that their services were fairly priced. The AMA is no slouch when it comes to lobbying.

Another likely scenario is Doctor A stays in business, funded by wealthier people who want to see the best doctor, thus creating a medical underground of sorts....and, eventually, substandard care for those who can't afford to pay out of pocket.

I personally do not like to see any more aspects of our lives put in the hands of the federal gov't. The less bureaucracy the better. I mean, we have all seen what a resounding success medicare and medicaid have been right? As far as alternatives, I would have to think for a while, but simply insuring the entire country would IMHO just drive costs higher. Further isolating people from the actual costs of their medical care will only serve to eliminate any incentive for competitive costs. I also do not think it is a good idea to have the gov't tell doctors what they can and cannot charge for services. Isn't that the same thing HMO's always get lampooned for doing?
As far as prescription drugs, the costs are unreasonable, and that needs to be addressed. We don't need to use more of our tax dollars to subsidize their purchase. As of now, drug companies can use advertising costs as much as R&D costs in the pricing of their medicine, which I think is ridiculous. I hear that stupid "Do you know about the purple pill?" commercial at least 3 times on my home from work each night. I mean come on. And we can buy drugs in Canada for 1/2 what the companies charge here, but of course the companies are fighting to stop that. The fact that many in Washington are in the pockets of the drug companies is an issue as well, in my mind further illustrating the fact that we don't need to give control of our health care to the gov't. America has also become pill crazy. People have high cholesterol and instead of asking them to stop eating hamburgers and fried chicken every day, the doctor gives them a prescription. To me, it seems we are often times just medicating the symptoms instead of actually addressing the problem that is causing those symptoms. Although I don't think the gov't can start putting surgeon general's warnings on BicMacs, because we see how effective those are on cigarettes.

So much of medical expense would be alleviated through torte reform. I suppose there was already a discussion about this, but I think it fits here, too. If we were to adopt a 'single payer' system where the government paid for medical care, we would be forced to eliminate many of the lawsuits.

Perhaps some of the people who tout the socialist, European medical system would be surprised to know that doctors are protected from litigation (at least in Italy, which is my only true frame of reference). A doctor performing an operation in Italy requires the patient to sign a waver foregoing all rights to sue in the event that something goes wrong.

If we were to adopt the same system here, there would not be a need for government sponsored healthcare to begin with (IMO).

Sorry, but there is presently very little in your life that isn't directly or indirectly monitored or directed by some level of government. Single payer is not ideological, it's pragmatic. It lowers the cost and makes basic health care available to everybody. If you have a severe accident you're going to get ER treatment anyway. Why not have everybody kick in and get some economies of scale? The sheer simplicity of it appeals to me.

If you read the link, the level of overhead is considerably less in medicare than in private plans. So much for bureaucracy. Just out of curiosity how many people do you know that want to get rid of medicare? Relatedly, what is the percentage of Canadians who would prefer to get rid of their considerably less expensive public medical system and switch to the more costly American approach? Your ideology in a vacuum is not very convincing.

I agree that learning good health habits would make a contribution. The profiteering of the fast food industry seems to be an important factor here. I would guess healthy eating habits is more derived from a solid nutritional education than being motivated by the terror of inadequately covered sickness.

By the way, the Surgeon General's warning on cigarette packs was a very effective deterent and tv ads against cigarette smoking have further reduced smoking. In California, which does both, we are down to a smoking percentage of 16% which is unprecedented. I remember when I was young when you went to a party half the room was smoking. A smoker is a rare bird now and those who do are asked to take it outside.

Dingo, sign me up. There are too many flaws in our present system. It hurts doctors, patients and medicine in general.

I do not like the effects the free market has on health care. Drug companies search for profitable products for treatments over cures. Individuals cannot move jobs because they are tied to their group insurance by a pre existing condition. At the very least we should all be considered part of the same group.

As someone typing on a doctor financed keyboard I know one thing, single payer would only help me. Right now I have very little health insurance and it has never paid for any of my medical care, with single payer I get better health insurance. The doctor in my family doesn't take insurance or Medicare now either so I'm not hurt there. For doctors who are going to take single payer health insurance this could mean all medicare paitents (BAD).