Kucinich Supports Single-Payer Plan

by L.A.S.

With all the news coming out of Washington this week regarding Obama's national health care proposal, it is difficult to focus on just one or two threads for an article or discussion. But one major thread is that Dennis Kucinich is again taking the lead regarding national healthcare, and has come out in support of a single-payer plan.

The alternative news site AlterNet has been very enthusiastic about his version of healthcare reform. You may read their article here: www.alternet.org/blogs/politics/141404/how_dennis_kucinich_may_save_the_health_reform_battle/

Kucinich would allow states to create their own single-payer programs. This is a positive step. However, in the current economic climate, I doubt that many states are in any shape to start up a new public benefit program. Some states, like California, are dropping eligible people from the public healthcare programs that they already have.

Perhaps Obama's plan is meant merely as a transitional phase from the present multi-payer, all-private (except for Medicare) situation to a true single-payer plan such as one finds in many European countries and Canada. I could live with that, but I think that the insurance companies are bound and determined to avoid covering the people that they do not want: those who have pre-existing conditions, and those who run up large bills.

We saw when Medicare first was rolled out as a result of the President Johnson initiative under his "Great Society" programs, that the insurance companies could not dump the seniors fast enough. In fact, they terminated policyholders even before they had been formally enrolled into Medicare! Let us hope that someone has thought to insert verbiage to prevent a similar fiasco this time around.

One approach to reducing the cost of medical care that is not used enough is to manage cases for improved drug therapy (and other management of chronic conditions) so that patients spend fewer days in the hospital. This requires a progressive attitude!

One may read a rather long article on the Nursing Center website about interventions with high-risk or at-risk families on Medicaid, or on a public health plan in other countries. Typically, visiting nurses make regular home visits and help to educate parents and monitor the progress of children in the studies. Overall, such intervention returns about $17,000 per family in the program (they take into account not only hospitalizations that have been avoided, but also crime and domestic violence, and other costs to society: "Cost-benefit analysis of the NFP reveals that there is a $17000 return to society for each family served by the program.13 These benefits were calculated on the basis of the program's impact on societal outcomes such as crime, substance abuse, teen pregnancy, child abuse and neglect, and domestic violence.")

Let's hope that such relatively low-cost interventions will be the norm, and produce better management of childhood asthma and other chronic conditions.