Most Doctors oppose Universal Healthcare, and I think the Democrats are worried about Doctors in ads opposing their plan.

Also, the healthcare industry has a huge amount of power. I think a steady expansion of coverage within the present system will eventually force the issue, resulting in universal healthcare, BUT at present people aren’t ready for it.
Part of the problem is the extent of common wisdom on this issue. Many Democratic candidates don’t believe universal healthcare can work. Most people in the media don’t believe it. It is such a given, that people just assume its hopeless, and that’s true throughout our population. Indeed, the only people who seem really confident and CONVINCING about universal healthcare are people who are public policy experts on this issue, and NONE of the candidates are that. Ironically, I suspect Kucinich doesn’t even know all the facts well enough to convince me that Universal healthcare is good (no snipe at him, it takes years of research to determine whether this change would actually be for the best)
This country won’t accept Universal Healthcare yet, it will take an emergency to force us to.

Also, consider that the Republicans can also find (or manufacture) doctor organizations in opposition to ANY Democrat’s health plan. As Kuttner says, since we’ll be facing that anyhow, why not support the best plan?

I don’t beleive that most Dem candidates are against universal health care; I suspect that most of them privately think it’s a good idea (the results in Western Europe speak for themselves), but doubt it’s a viable political position, as you do.

As for what most Americans believe - the polls seem to indicate that Americans are far more open-minded than you give them credit for. And I think if leading Democrats started talking about universal health care as a doable, mainstream proposition, much of the press would follow suit.

Thing is, not everyone thinks single payer is the best way to allocate health resources. Blaming the dems for being cowardly on this issue is unfair - its hardly a consensous, even on the left, that single payer is the way to go. It, like all other systems, has real problems. Call the wrong, if you want, but, frankly, I think you are way off to call them cowardly. Each candidate (except Graham, I believe, but I am not sure) has advocated a rather large government mandate to ensure almost everyone in the country. In the current era, that is not an act of cowardice.

On a related note, aren’t some of the Democratic canidates (I’m thinking specifically here of Governor Dean, but I’ve heard of other canidates who have similar plans) advocating some form of universal health care? I know some of them propose it in incremental steps, but would that not be standing up for universal health care?

And, MD, I wish you’d stop with your damn saw about how “doctors don’t go for it,” as if you A) had the ear of every damn doctor on U.S. soil, B) believed to your soul that doctors, like the Pope, are infallible and above questioning, C) think that doctors, like other humans, could not be persuaded to change their minds. It’s annoying. Why don’t you put up some hard data (preferably not funded by the AMA or some other big-money behemoth) or just knock it off already ?

Second - I never claimed doctors were necessarily right. I just claimed that they were given a certain amount of respect on this issue. They could be wrong, their expertise is medicine, not public policy OR economics. Now, what do doctors think? I never claimed they ALL think single payer is bad. I claimed that most did. I could be wrong. This is built on extensive experience in college working in labs with doctors, studying in classes with premeds, etc. It’s a limited sample, but it’s what I go on because I have a real distrust of polls. However, you want polling information, so go find it. I looked for thirty minutes, and I couldn’t find anything that wasn’t obviously biased (most of it was against single payer, but I’m not posting anything from the Heartland association). Now maybe you have a point, I spoke to definitively on a blog posting board. Sorry. Fine, in my experience, many doctors have voiced extreme opposition to a Canadian style plan.

THIRD - Dean’s plan covers everyone under 23, everyone over 65, and with insurance support for small businesses, covering MILLIONS of the working poor, and indeed covering most of the people who are uninsured today. It may not be single payer, but to the millions of Americans who it would cover it is much better than what we have now. Saying that single payer is the best solution and therefore only solution seems like saying there’s no point in the government providing scholarships to kids to state schools unless it can make those schools free. I wish they were, it may not be possible.

FOURTH - There is one other potential problem with single payer. I talked to a public policy professor who supports single payer, and he told me that a lot of Canadian doctors do leave Canada (relative to the number of US doctors leaving the US), and that they have responded by training more. Unfortunately, it’s hard to determine WHY Canadian Doctors leave Canada. This doesn’t refute single payer (at least not in his mind, and I think he knows his #*, and that’s fundamentally why I tentatively support single pary)

FIFTH - You ask, why not support the best plan? Well I ask you, why don’t you support these Democrats? Specifically, I thought you said that you would vote Green next election unless Kucinich gets the nod. What you’re saying is that the Democratic Coallition doesn’t offer enough to the progressive wing of the Democratic Party. Personally, I think covering the vast majority of the uninsured IS enough for me on the healthcare issue. Apparently it isn’t enough for you. That’s fine, but stop acting like we’re all cowards. I really care a lot less about whether we have the BEST PLAN than I care about the fact that millions more will be covered.

SIXTH - I think that IS LEADERSHIP. IT is SHAPING PUBLIC OPINION. These Democrats are making bold statement about government working to improve the lives of millions at large costs. They’re trying to do it in a way that keeps the insurance companies somewhat at bay and refutes some of the counter-arguments (2 valid ones I mentioned here). They’re talking about fundamentally reconsidering the role of government, about making government also about providing healthcare. Now, maybe its not leadership because it isn’t the perfect Leftist Public Policy Solution, but is it really so unsatisfactory? I don’t think so.

The poll result showing that extending healthcare to those 41 million rather than cutting taxes ISN’T support for single-payer. Don’t equate the two. I think Americans could reasonably respond one way to the first question and still be deeply opposed to single - payer (many Americans might be comfortable with improving the social safety net, but not with total equality in healthcare. OR they might be fine with that but uncomfortable with a centralized government plan) I don’t know, but honestly, I haven’t seen any evidence that they DO support single payer, so I’ll wait for it. BUT in the meantime, the poll you point to is exactly in keeping with Gephardt and Dean’s stances on the issue. Cool. Now, personally, I think there would be a lot of opposition to single payer: I think the common wisdom that its bad for R&D and Doctor retention seems to run pretty deep (but once again, that’s based just on my experiences and talking to people. Lord forbid I overstate my knowledge. Perhaps I best shut up and never talk again given that I don’t have the time or resources to conduct polls and find data supporting my every assertion).

Given his record with Pharma, I wish you luck once President Wannabee’ Lieberman is crowned at the convention. :(

Specifically, Dean said 3 years ago at my college that every Doctor, when prescribing drugs, should enter that drug into a computer which would then spit out a list of drugs that contain the active ingredient AND the prices. Doctors would then choose the Drug that was cheapest that did the job. This would really encourage the healthcare industry to cut prices, get doctors to ignore ads more (because many doctors prescribe the expensive advertised drugs because they don’t know about the generic cheap ones), and encourage efficiency and real R&D. I think that’s a substanceful proposal that seems common sense that would have a major impact and that doesn’t require a complete transformation of the healthcare system.
Also, I haven’t heard Kucinich propose that, but Dean has. I guess I just object to the implication that Kucinich is the only Left of Center candidate, the progressives only hope. Here you lump Leiberman in with Dean and Gephardt and Kerry. I don’t think that’s fair. Also, given Leiberman’s trouble raising money and in many polls, I don’t think you should assume the Dems will “corronate” him. If they do, I’ll be really darn disappointed, and I probably won’t donate my small amount of available funds to his campaign. I think a lot of Dems know a lot of their base feels this way.

1) My impression is that many - perhaps most -doctors support single-payer type systems (and remember, canada isn’t the only example of such a system in the world) - including my father, a doctor who has practiced in Canada and the US. In recent years, frustration with how HMOs pressure doctors to provide less care per patient has made a lot of good doctors more interested in alternatives. However, I grew up mostly in the Northeast, where people (including doctors) are more likely to be on the liberal side of questions, so take that with a grain of salt.

2) More doctors move from the US to Canada because doctors here get paid more. No mystery, and also not an argument against single-payer here.

3) I never said that I wouldn’t vote Dem unless a miracle happens and Kucinich got the nod. I haven’t yet decided how I’ll vote; it depends on a lot of factors that I’ll post about more as the election gets nearer.

4) The problem with the Dean plan is that it doesn’t really cover everybody. As his website says, “As a Governor, I am proud that virtually every child under 18 and more than 92 percent of adults in Vermont are eligible for health coverage.” Aside from that 8% (why aren’t they eligible?), there’s the fact that being “eligible” for health coverage - meaning that if you have the money, you can’t legally be turned down by insurance companies - isn’t the same as having health coverage. It’s not universal coverage, and it won’t be able to mascarade as universal coverage for long, if Dean becomes the nominee.

What’ll happen for most uninsured poor adults, under Dean’s plan, is that they will have insurance made available to them through their employer. That’s an improvement over the current system - but it still won’t help someone who can’t afford to have a health insurance bite taken out of an already small paycheck.

The grants for people who are unemployed will only help those people who can get through the maze of regulations involved in applying for a federal help program - people who don’t have the skill or determination to deal with that system will remain unemployed. And since a disproportionate number of those people will be people dealing with chronic health problems (having a chronic health problem makes unemployment more likely, and makes lacking energy and drive - not to mention depression - more likely), to a great extent Dean’s plan will fail to be accessable for exactly the people who most need subsidized health care.

Finally, a lot of Dean’s plan seems to consist of unfunded state mandates - that is, the states are supposed to cover a significant chunk of it. With what money are the states going to do that?

That’s not universal health care, and don’t pretend it is.

5) The biggest avoidable cost of the US health care system - what makes us most expensive per capita compared to other first-world countries - is the waste generated by having to support the enourmous bureaucracy created by having a huge hodge-podge of private and public insurance schemes. As Kuttner writes:

Costs keep escalating for three distinct reasons. Science keeps inventing new tests, new treatments, new drugs, all of which add to the overall costs. The population keeps aging. And the system is stunningly inefficient, with its patchwork of fragmentary health plans and its profiteers taking bites out of each medical transaction.

If we leave intact the present system, with its wasteful fragmentation, billing, underwriting and insurance company profits, there is only one big place to reap savings — by withholding more care as nonessential and by avoiding the sick.

The choice really is that stark. The current increase in medical costs in the US is unsustainable; we have to save money somewhere. If we don’t do it by cutting the profiteers out of the equation, corporations will do it by finding ways to offer less health insurance to employees. Any plan like Dean’s which relies overwhelmingly on employers providing health care runs into this problem.

Real universal health care means that any American can make an appointment with any doctor, walk in, fill out a simple, single-page form (just enough for I.D.’s sake - name, address, SS number), and get treated. No HMOs forbidding you from seeing your doctor or bribing doctors to provide less care; no limits on which doctor you can see because your employer won’t cover seeing this doctor, only that doctor; no waiting all day in a depressing federal welfare office to apply for an appoitment to review the possibility of your eligibility and if you come back next week maybe we’ll have made some progress on your case. That is what the health care we should have looks like, and that is not what Dean’s plan - or any Democrat’s plan, other than Kucninich’s - can possibly provide.

Just a few thoughts. Also, Wampum had a post about Dean’s health plan that’s worth reading.

1) “Left of center” isn’t saying much, since someone like Lieberman - a right-wing democrat - presumably is the “center.” It’s true that Kucinich isn’t the only progressive candidate in the race; Sharpton and perhaps Moseley-Braun are about as far left as Kucinich is. :-) The others aren’t as hard right as Lieberman, but they’re certainly not from the progressive wing of the party, either.

2) “This would really encourage the healthcare industry to cut prices, get doctors to ignore ads more (because many doctors prescribe the expensive advertised drugs because they don’t know about the generic cheap ones), and encourage efficiency and real R&D.” Umn - economically speaking, aren’t generics “free riders” on the R&D done by the non-generic drug companies? In which case, increased used of generics will discourage R&D (assuming, as you have been, that private profit is what drives R&D).

it seems to me that most of the doctors i work with are not happy with the way insurance coverage works now. they spend way too much time worrying about whether or not their services will be covered. hospitals lose more money than could ever be imagined because of admissions guidelines that are dictated by statistics rather than real need (a very simple example is that among the various conditions that might qualify someone to be admitted to the hospital for an inpatient status according to medicare guidelines, the patient must have an oxygen saturation of less than 88%; medically, if an o2 sat is less than 90% it’s treated. these things add up. this is a very simple example and it’s far more complicated than this — i’m just trying to make a point. a tremendous amount of resources are dedicated to chasing down money rather that could be used to provide care.

i think what the doctors hate is all this dickering and second-guessing. it ends up not being about what’s in the patient’s best interest. if single-payor/nationalized health care ended up looking anything like the medicare system, it would totally, completely suck. being on medicare is better than having nothing, but it certainly isn’t the solution, and i think a lot of people flip in their minds to this model when they think of government subsidized health insurance.

the other example we have of health insurance in oregon is OHP. i posted about how abysmally bad that is on my blog. if national health care resembled OHP in any way, we’d all be dying on the streets. in fact, since the cutbacks for OHP, 22 people in portland have died as a result.

so, anyway, i’m rambling and not relevant to anything, but i really think it’s the insurance companies that don’t want single-payor and have the superpower to make sure it doesn’t happen. doctors, generally, seem to be invested in providing decent care for their patients.

***”it’s true that R&D is largely funded by the public. BUT I’ve never seen an analysis of percentages. What if private companies fund 30% or 50% or 10% of R&D (we don’t know, do we)?”***

Frankly, however much private companies are funding (I don’t know the exact amount, either) is probably too fucking much. A disproportionate amount of drugs developed, if you believe Public Citizen, are “vanity” drugs having to do with male-pattern baldness, wrinkles, and so forth. And the FDA often seems to do only the most cursory sort of testing on them, relegating the general public to the status of unwitting lab rats. Any number of uncommon diseases (as well as some not-so-uncommon ones) don’t seem to have anyone paying attention to them because profit margins are too low. It’s a disgrace.

If we can’t simply take R&D away from the maggots running Pharmas altogether, they should, at the very least, be A) Broken up, all the better to get more companies competing and producing more than just one or two pre-ordained test results B) Much more heavily regulated, with an FDA (or some international governing counterpart) with fucking teeth in it, for pity’s sake.

***”(snip)I think single payer and the complete running of the healthcare industry by the government really runs against a lot of people’s beliefs about the importance of private industry and private free market forces…”***

I’m really fucking tired of the free market telling me that I’m not entitled to healthcare if they, by their fucked-up whims, decide I can’t have it. My belief is that I deserve it and that everyone else does, too. This is certainly the opinion of most of the rest of the world, and far more Americans than I think you care to acknowledge.

***”I don’t think we’ll see a lot of candidates talking about how they want to hold pharmaceuticals accountable, because its hard to outline details.”***

Oh, bull. Any candidate who can hire a fleet of wonks to whip up colorful charts can come up with “details” and more. No, you won’t hear them talking about it because none of them have the stones to turn a big, fat campaign check no matter where it comes from. Same old, same old…

The Greens, at least, don’t take money from corporations, which is worth in my mind as much as yet one more half-baked plan from one more craven Democrat who tip-toes fearfully around Pharma and the HMOs’, as if they were cracks in the sidwalk instead of 5,000-Ton leeches bleeding the fucking country dry to line their own damn pockets.

“***…I guess I just object to the implication that Kucinich is the only Left of Center candidate, the progressives only hope. Here you lump Leiberman in with Dean and Gephardt and Kerry. I don’t think that’s fair.”***

I do, for a very simple reason. None of them has had to wonder for at least the last two decades, perhaps their whole lives, when they’re going to lose their healthcare, who’s going to care for them when they’re sick, how they’re going to pay their bills without being forced into banckruptcy, and so on. Sweet NOTA, do you honestly think a guy married to the heir of the Heinz fortune really understands, or cares, about things like that ? Give me a break. No, I’m not saying Kucinich is a saint, but he seems a tad more grounded in reality than the others, that’s for damn sure.

***”Also, given Lieberman’s trouble raising money and in many polls, I don’t think you should assume the Dems will “coronate” him. If they do, I’ll be really darn disappointed, and I probably won’t donate my small amount of available funds to his campaign. I think a lot of Dems know a lot of their base feels this way.”***

Well, that’s terrific. I hope you can find somebody in the DNC who believes you. I’ve already heard from countless Dems both here and on various blogs, that OF COURSE they have to vote for Lieberman because he’s NOT BUSH. You’d better yell a hell of a lot louder than those particular Dems while there’s still time. And you might want to lie about having “a little” money in lieu of saying you have “a lot” of money to dump into someone’s campaign. War is Hell, Soldier…