Medicare patients use hospitals far more than non-Medicare patients. It's as simple as not allowing a doctor who refuses Medicare to practice in a facility that accepts Medicare. In other words: "You don't like Medicare? Fine. Then you're totally free from even the remotest penny paid by Medicare."

Hospitals can't afford to lose the funding by siding with doctors on this one. How can any sane society let some small group of highly-trained technicians dictate policy?

I don't think that "doctors" are a homogeneous group that acts in any synchronous fashion, so some doctors won't take Medicare, and some won't take Medicaid, and some won't see charity patients, and some want cash up front, and others, many others, are motivated by more than their income as a determinant.  However, economics, in medicine, forces a lot of action that doctors don't like, and there is no endless supply of ideal patients who pay what the doctor thinks his work is worth. Doctors will adapt to their environment, or seek other more favorable environments.  Beverly Hills and Newport Beach can support only so many doctors.  It depends where you live, and they live, and it depends upon their view of medicine as profession or as business.  It's a challenging mix with many, many factors.  Of course, if the supply is increased by subsidizing medical education with a payback to work a period of time in underserved areas, in a practice setting that is convivial, much progress might be made, but not if the concept of a physician is reduced to "small group of highly-trained technicians."  That's an adversarial slap in the face that doctors will almost uniformly reject, even the ones who clearly fit that description.

Patients, meaning all of us, need to listen, sometimes, when doctors discuss the satisfactions and motivations of their work, their profession. The description you offer, when it becomes a mindset, risks extension to being a self-fulfilling prophecy. 

You mean Pelosi is a Weasel... Please reread.

No wonder Kucinich was heard saying behind the scenes, "I don't give a f*** what Nancy Pelosi does."

Kucinich is looking out for us, apparently Nancy sold out. I received many emails over the weekend regarding fighting for single payer amendment and that she had single payer advocates removed from a protest before they passed the bill.

I guess she's on the same page as Obama, that it would disrupt the insurance industry. That was 9 months ago when we wanted to play nice. Now that the insurance industry is playing dirty single payer should be back on the table STRONG.

I'm so dissappointed in congress.

Lauren,

We need a lot more idealism on this issue. Keep aiming high!

I want to think they will strengthen the bill in the Senate and congress, but all the Hill vets are saying good luck with that. Weak, weaker, and weakest.

Other countries have instituted health care reform and kept private insurers in the mix. They mandate that everyone buy health insurance and that all the health insurers be non-profit under a principle of solidarity.  In the United States, this solution was never even discussed let alone deemed politically infeasible.

Our "uniquely American solution" to health care reform was doomed to be convoluted from the start.

Other nations that use private plans do so within a program of social insurance whose emphasis is on cooperation. Our fetish for competition lead to the promotion of a health insurance exchange containing a public option with a mandate that everyone purchase health insurance and subsidies to make that purchase as a concession to private insurers to include people with preconditions and forbid the practice of rescission.

Under H. R. 3962, the taxpayer will be subsidizing the profits of Wall Street for some time to come. Hopefully Republican fears are right and H. R. 3962 is just a doorway to Single Payer or some other more humane system.

Now that the House has passed our 'uniquely American solution" to health care reform, we can only pray the Senate will do the same. H. R. 3962 is far from perfect but it's a step, albeit a clumsy one, in the right direction.

My concern here is that when this effort fails after we wait many more years for it to unfold and take root, it will be labeled the "Democrats" plan and their failure to just leave it to the market, not control costs, and drive up the deficit, will put Republicans in office.

The idea that a third alternative, a move toward single-payer, non-profit health care and real universal access at a sane growth rate and taking only a fitting proption of GDP, will still be rejected by both parties and Americans will still not have a choice because the two party system is all they can recognize.

Even if the Democrats grow to back single-payer, they won't get the opportunity because their previous effort will have failed.

So, on State single-payer, will they permitted under the bill to pull their citizens out of the "exchange"? I don't think so.

From the Huffington Post:

"No other insurance companies will be told where and how they can compete -- only the "public option." How is that a "level playing field"? The end result is likely to be something called a public option, which is used primarily to placate progressives -- and which provides the political cover needed to force people to pay usurious private-insurance premiums. When this pseudo-public plan fails to deliver savings, reform opponents will use its failures as proof that public insurance doesn't work.

The plan will have low enrollment and little power to negotiate, causing the CBO to state as fact what I've long considered possible: That the public option could become a dumping ground where private plans jettison sicker people, while lacking the efficiencies of scale or negotiating power to get better rates or administer itself more economically."

http://www.huffingtonpost.com/rj-eskow/time-to-kill-the-pseudo-p_b_342370.html

Martin and Harold bring up excellent points.  I don't understand whether state options for single payer will be abolished in the house bill or in the eventual reconciliation.

The cost of what is being proposed will far exceed the estimates, and physicians will scream very loudly about any attempt to force them to take Medicaid payments and patients.  After all, you can't extend medical benefits to currently unserved people, and subsidize private insurance companies without inflating the cost of health care.  

Of course this will be blamed on the majority party, and may provoke a reaction that loses Congress and the Presidency.  Voters are idiots, again and again.

Finally, when the electorate accustoms itself to medical care, universally available, or very nearly so, and the astronomical cost of the proposed system, the rational solution, like a light bulb going off, will be either Single Payer, or more likely, a French or German solution.

The Republicans will not be able to cut off the universal care any more than they can successfully reduce the Medicare program to the shadow they seek.  Look at the Medicare Advantage programs which are the first in line for Medicare cuts.  That insurance company subsidy is being exposed for what it has always been, and the only people who support it are the ones who shout, "Keep the government out of my Medicare."

The big insurance lobby has managed to coral the public option into a corner in which it can cause them the least inconvenience. Thanks congress! :(

Has EVERYONE forgotten that on July 30, 2009, 53 members of the so-called "Progressive Democratic Caucus" in the House signed a letter stating that they would compromise no further and would NOT vote for a bill unless it contained a "Robust" public option?

Every single one of those quislings except Dennis Kucinich voted for HR 3962, and on the way to this "historic victory" they bargained away the hard-won reproductive rights of American women.

This bill itself aborts the idea that Health Care is a Human Right. We've got a LOT of work to do.

I hear you, he took a principled position, and I agree.  They also have to remember that being a woman isn't a "pre-existing condition"   :)

As well, no trigger, because triggers don't get pulled.  Also, please, advocate for singlepayer healthcare, with Community First Choice Option and CLASS Act (Community Choice Act for the handicapped, elderly, autistic, disabled, etc.); H.R. 676 & S. 703, are the best of the lot, so far; i.m.h.o..

Healthcare Reform Actions   :)

http://healthcare.change.org/actions/view/healthcare_reform_actions

http://www.change.org/profile/189788/actions

Related group and actions   :)

http://www.singlepayeraction.org//join.html

reality

the latest   :)

support women's healthcare now

http://womensrights.change.org/actions/view/support_womens_healthcare_now

As well, no trigger, because triggers don't get pulled.  Also, please, advocate for singlepayer healthcare, with Community First Choice Option and CLASS Act (Community Choice Act for the handicapped, elderly, autistic, disabled, etc.); H.R. 676 & S. 703, are the best of the lot, so far; i.m.h.o..

Related actions and group   :)

Healthcare Reform Actions   :)

http://healthcare.change.org/actions/view/healthcare_reform_actions

http://www.change.org/profile/189788/actions

http://www.singlepayeraction.org//join.html

reality