Someone on a message board I read suggested that government sponsored health care is "socialist". I don't think this has to be true.

It seems to me that the opposite of "socialist" is "market driven". Is health care "market driven" right now? Health INSURANCE purchases might be market driven. You or your employer look at a particular plan, then you look at the cost, then you decide if this works for you. I know when I review my own health insurance plan (that I pay for out of my business, but essentially out of my pocket) I look at a spreadsheet of plans with their copays, their percentages, their deductible, their prescription coverage, and finally their prices (at the bottom of each column). Then I make a decision: stick with what I have and pay the somewhat elevated premium, or switch to another plan, where I may have to jump through some hoops to get coverage because of what they might consider to be pre-existing conditions. That, to me, is "market driven". They're ALL expensive, but I pick the one that's the best bang for the buck.

But health care itself: You go to the doctor, they do something for you, you pay a copay of 5 or 10 or 30 or maybe 50 bucks, then you leave, and they bill your insurance for the rest. Is that "market driven"?

HMO's have nothing to do with being market driven. I'm not terribly familiar with medical HMO's, but in a dental HMO, they usually set the fees very low and you are required to take them. I believe that most HMO's reward physicians for NOT treating you. You get money whether the patients on your list come in or not, then maybe you get some token fee if they come in and have something done. You are NOT required to join one in the first place, and you CAN quit at certain intervals, and in dentistry, most of us do quit. They just aren't profitable in a quality driven business model.

PPO's are a little better. You agree to a discounted fee in return for getting patients filtered through your door. If you can live with 80% of usual and customary fees in your area (or 70%, or 60%, or whatever level of benefits they're negotiating) you join and you take the money. And patients might pick you based on your participation in said plan foremost, then whether they think you are the best, the most convenient, the most caring, etc etc. At least there is a "market based" component to this particular thing.

Then there's "fee for service". Patient comes in. Patient gets service. Patient pays bill. Sorta like going to the grocery store. Or Macy's. Or getting your hair done, or nails, or visiting a tanning spa. The only difference between those things and paying for your medical care out of pocket is that medical care is way more expensive. But so is a car, and tons of us can figure out a way to buy a 30 thousand dollar SUV. Or even a 10 thousand dollar used SUV.

The difference is, most of those other services are "wants", and medical care is a "need". Oh, not always - but often enough.

So, what is so different between the way we do things today and having a single, government-sponsored, health care payer? I submit that the answer is "not much". It certainly isn't socialism, any more than getting a PPO health plan through your employer is. But it isn't exactly capitalism either!

I journaled here about a letter to the editor of the Chicago Tribune from an MD back in December of 2007. In it I quoted a statistic given by that MD that 54% of the health care in this country is already paid by a "single payer", the Government. This includes at varying levels Medicare, Medicaid, VA Benefits and various other public health initiatives (and there are a bunch of them).

I also journaled here and here about the reimbursement levels, and cautioned that any government sponsored health care plan better take into consideration the people providing the care. Right now, programs like Medicaid don't pay enough to cover overhead expenses. And Medicare reimbursements are low enough that some MD's complain that they lose money at their rates. VA is different: Those are government employed physicians and health care providers working in government facilities and treating veterans. There will be a LOT of veterans coming into that system now, what with the Bush family running our country for 12 of the last 20 years. Perhaps THAT is the model to work with, and not single payer initiatives at all. I'd guess that a lot of those other types of public health programs, like the medical care given to Native Americans, would fall into this model. Pay your providers well, indemnify them against malpractice to a large degree, and staff government facilities that can be used at low cost to lower income Americans. They might not be the Cadillac care that some of us get now, but they could be Chevy care...perfectly adequate and better than what's available now.

I've said a bunch of times that people need to consider just WHO they want providing their care. You don't want overworked, underpaid people who are going to burn out early once their idealism fades in the face of real life's demands on them, and quit for something more relaxing and more lucrative. You want the best and the brightest. I don't believe we are always getting that now, with other fields being so much more lucrative and less stressful than medicine.

Sorry for the long entry, but there are a lot of thoughts in there, I think.