Regarding "Tricky operation" (Jan. 21) by Dr. Steve Calvin: Those on the left do not believe that "Medicare and Medicaid dollars flow from a magical federal fountain providing an ever-increasing flow that will never run dry." Rather, it is the excessive administrative overhead of our private health insurance system that is draining our country, its individuals and businesses.
A single-payer system would spend fewer dollars on administration. For example, Medicare, which is a single-payer system, spends less than 3 percent on administration vs. 15 percent to 20 percent with private insurance. Not only that, a single-payer system, by including everyone, would have greater ability to control costs by negotiating down the exorbitant prices Americans pay for prescription drugs. And it could create uniform reasonable transparent charges for other overpriced segments of our current system.
Fiscal conservatives might want to look at the savings single-payer could achieve, through stemming the flow of public dollars that are already being used to support our health care system. Not only does our current multipayer system prevent or delay individuals from getting needed health care, leading to unhealthier workers, but wages are stagnant and global competitiveness is reduced due to rising premiums.
Calvin introduces many important ideas for improving our system, such as regulatory reform, innovative efficiency, transparency, reevaluation of pricing, and roles of doctors and hospitals. But if the bipartisan Minnesota Senate Select Committee on Health Care Consumer Access and Affordability does not take a serious look at the elements of state Sen. John Marty's comprehensive Minnesota Health Plan, then it will fail to address the central issues it seeks to solve: access and affordability.
Dr. Carol Krush, Minneapolis
The writer is a retired family physician.
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Calvin provided good analysis. However, I would like to point out two misconceptions in his article: the idea behind the opposition to block grants and health care as a closed system. Calvin's argument that Democrats were against block grants for Medicaid due to their belief in the magical flow of cash misses a valuable point of opposition. The change to block grants gave no consideration to epidemics in a given year. If there is a higher flu rate one year and thus Medicaid spending increases and uses the block grant, then what? Do we kick people out of their nursing homes? Do we forgo services for the patients who receive Medicaid? This was really the issue, not the lessening of the magical cash flow.
The other point, not Calvin's but one I think needs to be addressed, is William Kissick's idea that care is provided in a closed system. Nothing in the world happens in a closed system. This is part of the problem when we attempt to use positivist research approaches in the real, open world. Any approach toward health care must be done through an acknowledgment that it is being implemented in an open and chaotic system.