Democrats Oppose Socialized Medicine

This was originally posted at Liberal Values, with some updates added in response to comments at a conservative blog. See original post for links:

http://liberalvaluesblog.com/?p=1288

This title is a somewhat tongue-in-cheek (while still accurate) way to describe the views of the Democratic candidates on health care as presented at the New Leadership on Health Care 2008 Presidential Forum. Whenever Democratic health care proposals are raised, conservatives start screaming "socialized medicine" but none of the Democratic proposals fit this by any reasonable definition of the term. Many conservatives reflexively refer to any Democratic proposal as socialism, even when their proposals are more consistent with the free market than the corporate welfare policies of the GOP. If we stick to more conventional definitions of socialism, it would suggest having government own and control the health care industry as is seen in some European countries. All Democratic candidates oppose such plans.

Democrats do advocate government involvement in health care, but this is not a radical change from the status quo. A tremendous number of Americans currently receive health care through Medicare, Medicaid, veterans programs, and other government programs. Increased government involvement is even welcomed by many businesses which are struggling to afford coverage for their employees and find that such expenses place them at a competitive disadvantage internationally. Under the current system 44.8 million are left uninsured, and another 30 to 50 million are underinsured creating a need for some action.

Dennis Kucinich advocates the plan which most greatly increases government involvement in health care. He opposes socialized medicine in supporting continuation of the current system of privately delivered health care, while eliminating the private health insurance industry by advocating a single payer Medicare for all plan. Such plans create confusion among those who don't understand the difference between Medicare and true socialized medicine.

I currently run a private medical practice and submit claims to both Medicare and private insurance plans. Under Kucinich's plan I would still operate a private practice, but would save a considerable amount of money by only having to deal with one plan. While conservatives cry "socialized medicine" to give the impression of lack of choice, Medicare typically places less inane restrictions on individual's health care choices than many of the other plans I deal with. Medicare wastes less on employees whose function it is to decide whether to approve the consultations or tests recommended by physicians. Medicare is also more reliable in paying the bills than many insurance plans which are basically schemes to take in premiums but avoid paying out benefits.

After Dennis Kucinich the other candidates keep much more of the private insurance system while trying to do more to make coverage affordable. The devil here is in the details. Barack Obama promises to provide details of his plan in the future but had little to say today. The Edwards plan could evolve into single payer as it offers a government plan similar to Medicare as one alternative. Hillary Clinton has never seemed to understand that her plan was rejected not simply due to the Harry and Louise ads but because it was far too regimented to be tolerated by most Americans. She also placed far too much emphasis on the HMO model, one of Richard Nixon's ideas which should be discarded as a failure. Rather than showing that she understands the problems with her plan, Clinton believes the answer is to sell the plan better.

Bill Richardson remains the candidate who might have the most experience and ideas but is also the most unexciting, including on health care. This is not necessarily bad as a simple pragmatic solution might be preferable to those which are more exciting. Richardson's plan is reminiscent of John Kerry's 2004 plan in allowing individuals the option of buying into the plan which insures government employees, including Senators. He offers tax credits to enable more people to afford coverage. His plan to expand Medicare to cover those between the ages of 55 and 65, while coming far short of Medicare for all, would still offer tremendous benefits. The older people get the more likely it is that they are unable to obtain affordable insurance, especially if they have any medical problems. Richardson also advocates allowing those in the VA system to obtain care from any hospital, which should please conservatives opposed to government-provided health care.

MyDD has provided summaries of the positions presented by the candidates. The summaries are worth reading, but the discussion has little more to offer as it primarily displays the irrational exuberance for John Edwards which is common in the blogosphere and ignores the less exciting proposals from Bill Richardson which have gained more attention in the media. As a large percentage of Americans who do have coverage prefer to remain with their current coverage, plans such as those offered by Richardson do offer the advantage that they are most likely to be accepted politically.

Update: A site which is properly named (although not for the reasons intended by the blogger) Health Care BS is linking to this post claiming that the "reality based community" is out of touch with reality. The post links to another post on the same site here which gives a totally inaccurate view of Medicare. David Catron make claims such as that "in their effort to dictate every nuance of an incredibly complex system, our masters in Washington have created a labyrinthine nightmare of conflicting priorities and incentives." The post claims that Medicare is socialized medicine, controlling the health care delivery system.

I deal with Medicare and many private plans every day and see how they operate first hand, as opposed to deciding how Medicare works based upon political philosophy. While I have other qualms about single payer plans, at present Medicare is one of the least restrictive and bureaucratic plans I deal with. For the most part I can practice medicine without having to worry about a set of bizarre rules. When there is a problem there is a fair appeals mechanism, which is rarely seen with private insurance. Medicare makes it faults, but at least their primary goal is to pay for medical care, as opposed to many insurance plans which play all sorts of games to avoid paying to increaes their profits. Before writing about who is out of touch with reality, Catron might want to actually experience the reality of practicing medicine or at last pay attention to those of us who do.

Update II: Much more in the comments following a response from David Catron. Following is a response to a comment from him where he argues "I think most of the physicians with whom I have worked would describe your positive comments about Medicare to be an example of Stockholm Syndrome." Following is my response:

David,

For someone with experience, you sure seem to have a tough time presenting meaningful facts and arguments. Resorting to bromides like “socialized medicine” or saying those who disagree with you are out of touch with reality or suffering from the Stockholm Syndrome just tells me that you have no coherent arguments to support your position.

Your background explains your lack of understanding of the issue. Hospitals and physicians are in totally different situations. I could understand that someone dealing with the hospital DRG system would be frustrated with Medicare. I’m sure you could come up with valid arguments agaisnt Medicare for all from your perspective, but again it doesn’t help your argument to resort to such specious debating tactics.

I’ve also found that, due to the differences in background, hospital administrators have a very poor understanding of physician issues. I would rather take someone off the street and teach them medical office billing from scratch than take someone trained in a hospital billing department and have to unteach them what they picked up there.

Arguments such as “I think most physicians” remind me of the Fox News tactic of prefacing Republican talking points with “some believe.” The average physician today is an employee or memeber of a group who has no experience with the administration of a practice and is not necessarily in a good position to compare the plans. A growing number of physican groups are now calling for single payer plans. Physicians have found that, despite all the scare stories about government plans, they are often more benign than corporate run plans.

For over twenty years I’ve been involved in the billing and administration of a medical practice. Every week I see what is and what is not paid, and where my staff wastes time fighting with insurers. Medicare is the least of our problems. Generally we submint a claim to Medicare electronically and in about three weeks we have a check. When there is a rejection I can usually go on line to their web site and find the pertinent rules so that I can adust the claim to get it paid. My staff often spends hours on the phone trying to fix problems with other insurers.

I don’t have to pay employees to call Medicare to get permission to run a test or to get a consult as is the case with many private plans. The one time I had problems with Medicare refusing to pay for a couple of items (with $13,000 at stake on one and $3000 on another) I was able to simply take the matter before an administrative law judge. All I had to prove was that my charges were for items which were medically necessary for the patient and consistent with current standards of medical care and Medicare was obligated by law to pay for the denied and future services. (One time afterwards I was asked about the same item when the Medicare intermediary changed and all I had to do was show the administrative law judge’s opinion and they never questioned paying again.) In contrast, private plans can simply decide internally that they will not cover something and there isn’t a thing I can do if they don’t want to change their policy.

From a patient’s perspective, they also do not have to worry about having coverage denied due to a preexisting condition, or losing their insurance because they become too sick. Medicare clearly explains what deductibles and copays a patient owes, while many private plans make this difficult to determine.

There are two situations where I do have problems with receiving reimbursement from Medicare. One problem occurs when a patient has dual coverage. Sometimes it takes months to sort out who should be primary and get them to acknowledge this and pay. Under a single payer plan this would no longer be an issue as Medicare would then be primary payer for all.

The second problem has arisen with the Medicare Advantage plans. Some are fine, but others engage in dishonest sales techniques and drag their feet on paying claims. Once again this is a case of the government plan being better than many private plans.

This is the reality of the situation for physicians–not a case of Stockholm Syndrome.

the average insurance company's overhead and administrative costs (which includes, of course, obscene salaries to top management and profits for their Repig shareholders) is about 30%. Medicare, on the other hand, devotes 3% of its expenses to administrative costs. Wow, that wonderful private sector sure is more efficient than bad ol' government, isn't it?

A few years ago I worked with a woman who was then married to a very Republican radiologist. She told me that her hubby was for single-payer health care on the Medicare model. His reasoning was simple: there would only be one type of forms for his office to deal with and one set of reimbursement rules, unlike the endless differences among various insurance companies. His guess was that he could reduce expenses in his office by 35% and better serve his patients under a single-payer system. Apparently he was not the only MD to think this.

Also, the average Repig voter or politician couldn't define "socialism" (and just what is so wrong with democratic socialism?) if the dictionary were opened to that page right in front of their face.

the democratic candidates were showing more leadership and vision on this issue. This will be a big issue in the election, second only to the war. The public will not accept a band aid solution to this problem. The majority of our candidates are offering half-assed quick fixes that won't work.