Another letter to the editor in that December 10th edition of the Chicago Tribune was titled "Paying for Health", and was written by an MD from South Barrington. In it, he suggests that access to care should be guaranteed for all Americans. He also suggests that we need to "convince ourselves that taxes should support health in America as public revenue does in other countries." He states that he is not in favor of a socialized medical system, but points out that 54% of our health care spending is already paid through taxes and programs like Medicare, Medicaid, Veterans' Affairs and other plans.

His conclusion is that there needs to be a single payer: the government.

When you think about it we already have pretty much a "single payer" for anyone over 65 years of age in Medicare. Would it be possible to start expanding this program, making it available to younger and younger people as time goes on? Increase the payroll tax to pay for the expansion. But there should be savings built into such a situation - perhaps someone goes to the doctor at age 60 instead of 65, finds out they have cancer, but it's stage 1 instead of stage 4. Would it be cheaper to treat that person? Or perhaps polyps are removed at 60 before they undergo cancerous changes. I don't know.

Looking at the dental model, I know that the people who are here routinely, every six months, usually require much less advanced care than the people who show up here once ever 2 or 3 years. We find things when they are smaller, we don't do as many root canals, crowns, etc on those patients. A root canal, post and a crown costs around 2000 dollars. A two surface filling costs around 150 dollars (in 2007, that is). Yes, there were 4 or 6 cleanings that were done, at a cost of about, say 900 dollars (6 exams and cleanings, 2 sets of decay checking radiographs, and one full set of radiographs). (again those are 2007 dollar amounts.) And who knows what else we caught on those 6 checkups? Who knows what we prevented?

Anyway, the point is that perhaps there are savings that aren't readily apparent if people are using their single payer insurance earlier, even while it's costing a bunch more to "cover" those people in the first place.

Could this plan eventually be expanded to include all Americans? Should it be? Those are hard questions, and there are many problems with doing that. But the bureaucracy is already in place for this system. Setting up another bureaucracy to deal separately with people under 65 would seem to be tremendously inefficient.

And would MD's be happy with it? I know a lot of them aren't terribly happy with Medicare now. They say it doesn't really pay them to treat their patients, not at an acceptable level. That's an issue that HAS to be addressed. And perhaps some of the addressing of it would come in the form of a paradigm shift in the medical community. That will be a hard sell, I suspect. More in a future post (I hope) about that subject...