The French system is like the U.S. system in that it is a mix of public and private. The gov't provides a basic health care package and anything above and beyond that one has to turn to a private insurer for insurance coverage or pay out of pocket. The French system is probably one of the best, but that isn't saying much given that it, like all the rest, is on an unsustainable growth path in terms of expenditures and their growth over time.

Your co-worker might think it is a single payer system if he is generally healthy and utilizes just the basic package.

I think it's critical that we not adopt such a system in isolation from measures to control costs other than by fiat

What sort of cost controls are you suggesting?

The American experience at the state level has been that political support for subsidized healthcare erodes as costs rise.

True but state budgets are far more limited than the federal.

In France, health insurance is a branch of the Social Security system. It is funded by workers’ salaries (60 percent of the fund), by indirect taxes on alcohol and tobacco and by direct contribution paid by all revenue proportional to income, including retirement pensions and capital revenues. On the surface, it appears that health insurance reimburses medical care providers less in France than in other European countries. However, more than 80 percent of French people have supplemental insurance, often provided by their employers. The poorest have free universal healthcare, which is financed by taxes. Additionally, the treatment costs for those who suffer from long-term illnesses are completely reimbursed.

Germany's system is more a single-payer system than France's but I think that the French system is a good one and the one most worth emulating. I don't oppose healthcare reform in the direction of something like the French system but, as I've written frequently, I think it's critical that we not adopt such a system in isolation from measures to control costs other than by fiat (which many assume is the unstated plan of those who advocate healthcare reform). The American experience at the state level has been that political support for subsidized healthcare erodes as costs rise.

Note, specifically, that France has a higher number of physicians per 100,000 population and the median physician salary is about 1/3 of what it is in the U. S.

Tlaloc, France doesn't have a single payer system. It has a government insurance program and it also has private insurance programs largely paid by employers.

I'll have to check it out more thoroughly, from my talks with a french coworker it sounded like they had a single payer system.

If you live in the Bay Area, 62k for a family of 4 is not much of an income

lol I wonder why?

could it be that your taxes are to high?

you should have gone to plan-o-parenthood for help with your budget, mabee you could have made it a little more easy on yourself with a family of 3 on 62K.

62k, lol, must be nice to be rich.

Three example of what I am talking about is the Massachusetts, California, & the Clinton plans.

I'm not familiar enough with them to understand that detail. I thought Clinton's plan involved expanding medicare while also having private insurers available. That means it still has all the various redundant bureaucracies that cost us so much money.

Single payer, we have seen, does not work well in Canada & the UK.

True but it DOES work fantastically in France for instance. You can certainly do single payer badly, the thing is there doesn't seem to be any way to do multipayer private insurance well.

Your understanding here is incorrect. I have detailed some of this above. I suggest you read HR 976. A summary is also available here.

There are currently some waivers for people over the age of 18. This law would have prohibited further waivers of this type and terminated existing waivers by 30 Sept 2008. This is under section 2111. (The term adult in the context of the bill is 19+)

An example of a current waiver program for childless adults: In Michigan adult waivers are currently available for those with countable incomes below 35% of the federal poverty level. That would be less than 8000 a year for a family of four. This will no longer be available in the new bill and those people will once again rely on the ER for their health care. This of course means that the hospital or the tax payers will pay for this at a much higher rate than if the waiver were to continue. This is probably financially a step backwards, but it was a compromise necessary to bring on more Republicans and make this a bi-partisan bill.

I'm genuinely asking.
Posted by Tlaloc | October 6, 2007 | 03:05 am

Our health care system is already in place, as well as competitive payer systems. What is lacking is making health care universal & a single core set of eligibility requirements & minimum standards of care.

Three example of what I am talking about is the Massachusetts, California, & the Clinton plans. There are others; I'm just not familiar with them. They offer what I see are the best chances for choice of provider & payer, competition of ideas for both care & payment methods, & the advantage of trying what works in one setting in others.
Under these plans, we can use to advantage system wide the medical records technology of the VA, cost cutting methods of the HMOs, & - I'm stuck but there are many others. With one set of eligibility & minimum treatment standards, we can eliminate much of the bureaucratic red tape & personnel costs by eliminating SCHIP, Medicaid, & all of the under the radar govt programs offering spotty coverage & roll them into Medicare. The VA & military systems I would leave intact at least for now because they each have expertise unique to them that can be used in other settings. However, most stateside military hospitals would no longer be necessary if a GI could access their health care anywhere w/o penalty.

Single payer, we have seen, does not work well in Canada & the UK. Well, it still works better than what the US has now, but we can do better.

Keep up the good work!

In other words, like the ADA, this legislation takes a good idea, and expands its scope and scale to become another huge government program by redefining words ("child" and "poverty") in a truly Orwellian (or even Humpty-Dumptian) manner.

This bill abundantly deserved to be vetoed.

It doesn't necessarily have to be single payer, but it does need to be a cohesive, coherent universal set of guidelines rather than umpty different programs with umpty different bureaucracies with umpty different sets of guidelines like we now have.

How would you do that without a single payer system?

I'm genuinely asking.

My other understanding is that those with household incomes up to $80,000 a year would still qualify for the program.

So we are being asked to pay for not only children, but also teens up to near adulthood, and from families with a high income too.

I don't know about anyone else, but when I look at a 17 year old, I see a child. Maybe the GOP's position is that 17 year olds should be working fast food jobs to pay for their health care. As for the 80k figure, that is just more nonsense from Rush. Do any of the parrots want a cracker?

If you live in the Bay Area, 62k for a family of 4 is not much of an income.

Pollibly the saddest thing of all is Bush, possibly the most out of control spender in history, trying to hide this denial of care for American children behind a facade of "being a good steward of the people's money".

Wrong. The states have to account for how the money is used. Florida lost some of theirs about 2 years ago because it wasn't used.

Fortunately if we replaced the whole shootin match with a *good* single payer universal coverage system it'd still cost us less than we pay now.

That's win-win (except for the socialism-o-phobes, but really, who cares?)
Posted by Tlaloc | October 5, 2007 | 07:25 pm

I believe that to be true. When we talk about the costs, we need to include all costs, not just the cost from taxes. It doesn't necessarily have to be single payer, but it does need to be a cohesive, coherent universal set of guidelines rather than umpty different programs with umpty different bureaucracies with umpty different sets of guidelines like we now have.

Then do.