Sin­gle payer, or some­thing else?

Re “State sin­gle- payer plan is doable,” col­umn, May 28

Los Angeles Times - - OPINION -

Yes, Cal­i­for­nia could do sin­gle-payer health­care. Un­for­tu­nately, it would be a com­plete dis­as­ter.

It would be too ex­pen­sive, and one state is too small a risk pool, but the real rea­son it would fail is the in­com­pe­tence of the gov­ern­ment. Medi­care, for ex­am­ple, faces in­sol­vency de­spite pleas from the trus­tees to ad­dress the is­sue. The De­part­ment of Vet­er­ans Af­fairs pro­gram is an em­bar­rass­ment. The Pa­tient Pro­tec­tion and Af­ford­able Care Act is cum­ber­some, and the cur­rent Repub­li­can plan is worse.

For­tu­nately, we have two mod­els that are worth look­ing at and would be close to the sin­gle-payer goal: The Fed­eral Em­ploy­ees Health Ben­e­fits Pro­gram and Medi­care Advantage. Both are run via pri­vate in­sur­ers and ex­pe­ri­enced per­son­nel; plus, we know they work, and the in­sured know they work. That gets rid of much of the un­cer­tainty that would ex­ist un­der a Cal­i­for­nia-only plan.

Why we have two such ex­am­ples of what works and still seek for some­thing bet­ter, I will never un­der­stand. Kevin Mini­han

Los An­ge­les

I am an in­sur­ance agent. I think a sin­gle­payer plan for all Amer­i­cans is the path this coun­try should take. Call­ing such a plan so­cial­ized medicine is a re­gres­sion to the red scares of the 1950s.

Hav­ing in­sur­ance com­pa­nies in­volved in our care is one of the ma­jor rea­sons why our health­care sys­tem seems so con­fus­ing and un­fair. It’s why there are no stan­dard­ized costs for hos­pi­tal stays or vis­its to the doc­tor. It’s why there are physi­cian and hos­pi­tal net­works that ex­clude you if you don’t be­long.

This is not the case with plain old Medi­care. Costs are stan­dard­ized, and if the hos­pi­tal takes Medi­care, it takes you. You can use it any­where in the United States.

Why should only se­niors get the best health­care in Amer­ica? Give it to every­body and join the rest of the in­dus­tri­al­ized world. Martin Schoen

Tem­ple City

In read­ing through Michael Hiltzik’s col­umn about a doable sin­gle­payer sys­tem for all in Cal­i­for­nia, I found a glar­ing omis­sion. Has any­body asked the tens of thou­sands of physi­cians in this state if they’re will­ing to ac­cept the much lower Medi­care or Medi-Cal rates as pay­ment for their ser­vices?

Th­ese ded­i­cated men and women strug­gled for years in med­i­cal school, and most racked up stu­dent debt reach­ing the six-fig­ure range. The piein-the-sky sin­gle-payer sys­tem would prob­a­bly re­quire all of th­ese doc­tors to ac­cept what would amount to a manda­tory, state-spon­sored, med­i­cal min­i­mum wage.

Hiltzik wrote all Cal­i­for­nia res­i­dents could seek ap­pro­pri­ate med­i­cal care from “any li­censed doc­tor in the state.” And that re­ally is the key, isn’t it? We would get care from those physi­cians who de­cide to re­main in the new state of So­cial­ist Cal­i­for­nia. Jim Rahm


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