Bonnie Nelson in Alaska sent my post and her comment about the Atul Gawande article in the New Yorker around to a number of activists saying she agreed with my take. (I had written that while we at Tikkun are fully in favor of single payer, Gawande “makes a very strong case that it is not ultimately who pays (private or public insurance) that matters: it’s whether the delivery of health services is coordinated for the good of the patient, and with accountability. It’s actually about putting the care back into healthcare”).

Jim Sykes
Jim Sykes responded to Bonnie that he disagreed, and gave me permission to quote him. Jim was the founder of the Alaska Green Party and has done very well as both a candidate for Governor and US seats. It’s a long post and the last paragraph is worth putting first so you know where he is going with it:
Get angry, get organized and make sure your members of Congress understand that the Obama/Congress/drug/insurance/health provider proposal is not acceptable. Even though these industrial behemoths are on board with Obama, it is precisely their weight and special interests that will guarantee failure. We desperately need a low cost universal system that is as good or better than the single payer systems that have proven themselves effective.
Jim’s comment in full:
“The articles in question were well written, but they left out and skirted important issues that need attention. While greedy doctors may be a problem, many are simply trying to pay off their medical school debts and are also victimized by insurance companies in a world where liability could have reasonable limits. While I hope that doctors work together for the benefit of their patients like they do in Grand Junction, but there is little incentive for them do do so (other than better patient outcomes). Far larger and more powerful forces that deserve the same kind of in-depth examination.
“Our health care non-system is in such bad shape that a myriad of huge problems need to be dealt with at about the same time. The real challenges are to provide access to health care for all Americans (including education and prevention programs) at similar costs to those of other countries who already do this at 1/3 to 1/2 what Americans pay.
“The phrase that “it doesn’t make any difference who pays the electrician” when building a house is not a good analogy. A better analogy is that we all pay for the fire department, but we only get service when it’s needed because community fire safety is important to all of us just as community health should be.
“It makes a difference who pays because the government should negotiate the lowest possible drug prices with manufacturers, the way that the VA already does. One standardized form would replace the 1200 that are out there now among insurance companies to save administrative costs. Several physicians have reduced administrative costs by seeing fewer patients longer and computerizing their records. A consumer review process could largely replace the huge medical insurance costs that many doctors now face.
“Significant medical costs will never be covered until everyone pays into othe system like social security. Younger and healthier people, who tend not to buy insurance, would pay into the system and also get benefits.
“Private insurers only want healthy people or those who can pay. Everyone else can go to hell. Even the insured get regularly denied benefits they paid for. The government can provide cheaper better insurance, because government doesn’t need to make a profit. Removing the corporate welfare will put 2% to 3% of the enormous health care billions directly to health care, education and prevention. Insurance companies can still make plenty of profit insuring cars, homes & boats, as well as additional health benefits that are not covered in a national plan.
“Obama’s main flaw is that the proposal doesn’t cut costs significantly. It continues to transfer our taxpayer federal funds to corporate welfare for drug companies, insurance companies and for-profit health care providers (and so called nonprofits too). So instead of getting those scarce dollars into actual applied health care, education and prevention, the Obama plan keeps the corporate welfare in place which means that significant cost savings cannot be achieved.
“The major undiscussed problem is enormous campaign contributions from drug/insurance/health providers to most members of Congress. Until MC’s care more about their constituents health instead of their campaign coffers, little will change.
“Single payer systems have largely accomplished health and cost-cutting goals in most industrialized countries and all of them have better general health than the American public. We need to remain open minded about the best system we can design, but if it doesn’t beat single-payer at least we know that single-payer works. So long as the insurance/drug/health care co.’s continue in their current role–they will never voluntarily cut their costs or their profits.
“So if Obama and the 535 MC’s don’t have the guts to take on the health/drug/insurance cabal that essentially keeps us from having a decent system, then it is up to the people. And I don’t yet see the level of anger–but that’s what it will take. Obama needs to meet or beat the lowest cost of the world’s single payer systems.
“Patients are treated as a business commodity. Only the government can guarantee that the funds will be applied directly to health care the way that the fire department applies it to fire prevention and fire fighting. If we privatized the fire department like we do health care I imagine there would be a lot more fires and chaos that would be unacceptable to communities. So why do we let the purveyors of corporate welfare abscond with dollars that belong on our health care? We shouldn’t.
“Get angry, get organized and make sure your members of Congress understand that the Obama/Congress/drug/insurance/health provider proposal is not acceptable. Even though these industrial behemoths are on board with Obama, it is precisely their weight and special interests that will guarantee failure. We desperately need a low cost universal system that is as good or better than the single payer systems that have proven themselves effective.”