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May 22, 2009


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James Biggerstaff MD

Single payer is not the answer and will lead to severe rationing of care, especially the elderly.
"Medicare works pretty well" except for the fact that it is going bankrupt.Why would we want to put more money and people into a bankrupt system?

The PNHP, SEICU,etc are special interest organizations who advocate the complete takeover of medicine by government in a single payer system. They refuse to release their membership lists and though they claim that the majority of their members are physicians it is thought that only about 10% are practicing physicians.
I would hope that this organization would avoid these fringe groups.

Keisa Bennett

I'm not sure single-payer is the answer and I encourage people to advocate for whatever financing system seems the best for patients (consider direct payment for primary care and let regulated insurance companies do catastrophic and specialty care?). However, as a Family Physician at a Community Health Center, I agree that we currently have a system that involves a lot of rationing, and in fact, is quite "socialized." We are all paying for each other's care; it is just disguised by insurance companies and 3rd party payers in general. Unfortunately our current "socialized medicine" does not get people the care they really need. The working class and Medicaid recipients in some areas struggle to get access and quite commonly wait months for appointments and imaging. Meanwhile, well-insured patients (including Medicaid in other areas) often end up with too much care; taking medicines and having tests that are actually more risky than beneficial.
We must keep in mind the principles of equal opportunity to basic primary care and chronic care management with the goal of keeping most citizens out of the hospital and functional within their communities. Keep up the advocacy!

Susan A Miller MD

Gordon, If you want to see a lot of these heartbreaking stories go to "Death by Spreadsheet" on the Healthcare Now website. Has this group thought of joining the Leadership Group for Guaranteed Healthcare? It is the umbrella group for single payer in the US including PNHP, CA Nurses Association, PDA, SEICU, and lots of other groups. I know folks have tried to stay away from the financing part of this discussion and don't want our work on the delivery side to be politicized but NOW is the time to speak up before the entire reform process is hijacked by the insurance industry. I personally feel a lot more doctors need to get arrested for the sake of our patients before we can turn this thing around.

Mike Barron

Another common strategy implored in Illinois by the private company hired to run a medicaid HMO:

1) entice patients to join plan with gifts and promises of free transportation
2) keep reimbursement to doctors so low that none can afford to accept patients with the plan
3) contract with one or two docs in area so plan can say that their services are available; however, patients wait months to get in to be seen
4) trumpet savings as plan participants seem quite healthy; they rarely see doctors, use lots of OTC meds, and nobody is ordering expensive tests on them.


Here is an all to common story of obstructionism by an insurer. I am sure that the idea is to place out so many hurdles that people give up.

I prescribed a pain patch for a patient. She has a chronic complicated condition we have used many other pain treatments for. The patch is a well known mild medicine and safe . I had no idea she never got the medicine til about a month later when I asked her if it had helped.She said the pharmacy told her I had to do a prior authorization . Normally pharmacies tell me this, and I do the paper work. This one I never knew about.So after that month of delay I did the paper work This took my time the pharmacy's time and the patient's time .PLus she was in pain . The insurer instantly approved it.Makes me wonder that this was just a formality- at my expense.
What a waste of time.Give us a simple straightforward system where patients come first

here is one more- my husband received a letter saying that his medicine was suddenly going to be limited.He could get now only up to a certain amount but over that was not covered .He has been on this dose unchanged for a long time.The letter came under the guise of "Blue Cross has reviewed your medication. We feel it is in your best interest..." when only one's doctor can know what is in t he patients best interest and this was clearly about money .The letter came from a pharmacist in Ohio
I complained to the insurer and I called the pharmacy . It turns out that his medicine is covered just fine- it is just that the doc has to write the script for a higher number of miligrams to be in each pill. This was not what the letter stated
Another vague obstruction wasting time, frightening patients
Give us a simple straigthforward system.


My daughter obtained her teaching certificate two years after she graduated from college. As long as she was in school, she could get student health insurance. After she left school, she couldn't get group health insurance through the alumni organization because she hadn't gotten it right after graduation--even though the same insurer provided both student and alumni plans! When she applied for individual coverage, she was denied--and one of the reasons given was that she had had one prescription for allergy medication. This was not a matter of her not being willing to pay for it, or of having been irresponsible. It's called cherry picking, and a lot of responsible working people are denied coverage because of it.


It was depressing to me when my 5yr old who was injuried had to have handy therapy. Both I and spouse work full time and we are healthy with no preexisting conditions in our family. We had to pay $ 1200 because they Aetna insur said the person who we saw was out of network but we had no choice as the person who was in network was on maternity leave and not many hand theparists in our area. We did not know what a run around it would be when we needed care and that
insur just looks for reasons not to pay for care. I must have spent 6-8 hr on phone with my insur and it was such a disgusting experience! If this is the treatment for someone who has no preexisting issues, I pity anyone who needs insur and uses it regularly. Why the in the world are we worried about private insur who pay 30-40 million executive packages, they will figure a way to survive by being nimble. Aren't private companies supposed to be creative and efficent? If they are not then they are not really offering us anything to help consumers. Consumers need better choices, they will pick what suits them.I fed up hearing govt control, no one is proposing taking away private inur or shoving anything down anyone's throat. Health Beat by Maggie Mahar is proposing involvement from responsible people on her blog to stop untruth facts and busting them with evidence.

Jeanne Ertle

DoctorSH: Please take a look at the health care provided in the rest of the industrialized world where there is a high degree of satisfaction among health care providers and the public. The US ranks 37th in the world in health outcomes and yet we're paying up to twice as much as other countries.

Medicare is the best example of a single payer system we have in our country and it works pretty well with far less interference between patients and providers than in private insurance. This, in spite of having an "undesirable" private health insurance population and being underfunded.

I highly recommend "Health Care Around the World," a PBS documentary that examined other health care systems and compared them to the US. We were found lacking in just about everything related to health care. I also recommend you check out Physicians for a National Health Plan at http://www.pnhp.org/.


Gordon: We all know change is needed. But is the change needed a govt takeover of the system? We can argue and sue a health insurer. We can not do the same if the govt is the authority.

I am a bit disheartened if you are advocating giving the govt more control, when it is the lack of individual control and responsibility that has caused a great deal of the problems.

John Haresch, MD

The irrational rationing is spreading rapidly in my experience in working with patients on my sliding scale and in our free clinic. There are plenty of formerly productive employees and small business owners in our area who cannot get needed health care, and there is nothing rational about that. One patient is still pushing himself to work, even though fatigue from gastrointestinal blood loss is making it difficult. He cannot afford health insurance, and he has not been able so far to get the diagnostic tests he needs to diagnose his problem, which could be cancer. His story is not unique. This is how we should be rationing health care??

aldebra schroll MD

I have recently had patients denied insurance due to mild arthritis observed on a chest x-ray, hemorrhoids and “minimal cataracts” observed by the ophthalmologist when I had referred for a completely unrelated issue. Patients become quite upset to learn incidental findings are keeping them from being insured. I am upset to think that a thorough history and medical exam performed as I was taught could lead to patients being denied coverage. Somehow we never covered this in medical school.

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