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April 10, 2007


Have you contacted Al Franken with this? [VERY good job, BTW.] He's a HUGE Wellstone fan, and with him running for Senate in MN, there's a chance for this to get more traction, both in MN and across the nation.

Thanks again.

Thanks again Sara. I can't tell you how much I appreciate your pieces and the education you provide so graciously.

I still would like to see each senator, representative and all of their staffs given $600 a month to buy health insurance on the open market and deal with the insurers and physicians. Then I would like to see 5000 uninsured put on the federal government health plan. Compare their experiences two years later. I really think that single payer coverage would be possible.

Very nice. I love that you put out Paul's work to build upon. Thank you.

ps the ecologist in me says it's "Niche"

Niche. It's French, I believe.

Over 60 years ago one of my uncles wrote a paper on why health care should not be done for profit. He was right. The only way to get from here to there is to make the non-profit sector sufficiently attractive. Many doctors like the Kaiser system because their judgment isn't questioned and they don't have to justify anything they order to some bean counter. They are free to just practice medicine, and that is worth somewhat less pay.

The idea of fully paid medical education in return for x numbers of years in underserved communities is good. This is another way to make "non-profit" medicine attractive. If the for-profit outfits have to charge more to cover their highly paid doctors and administrators, they won't be competitive.

But the key seems to be to require community-based rating. This disallows cherry picking, where companies profit by dumping the sickest people and refusing to pay for care for the rest. If there were reasonable alternatives where people knew they would get good care, like Kaiser, why pick one of the companies that hassle about everything?

In short, focus on taking the profit out of for-profit medicine, and we will be able to make some progress.

Thanks for such a lucid representation of Wellstone's ideas on health care reform/repair.

ps, the philospher in me says nietzsche... doh!

As a Canadian living in the US I am astonished that Americans actually believe the hype that the insurance industry flings around when trying to make everyone afraid - seems that fear is the best weapon they all have. Healthcare in Canada may not be perfect, but its worlds apart from the mess in this country, and no one there has to worry about going bankrupt or losing their house if they get cancer. The United States is the only industrialized country in the world that doesn't have some form of universal and not-for-profit healthcare - just because the insurance and pharma industries have apparently purchased every member of congress (with the exception of those wise few like the late Sen. Wellstone) doesn't mean that the American people have to just take what's dished out by their "government". Its time to get out in the streets and start yelling blue murder - remember, there are more of us than there are of them.

Maulmom -- Franken thoroughly understands Wellstone's experience with this set of issues, and if and when he is elected, I am sure he will pick up much of what Paul left on the table. They were friends from before Paul ran in 1990, and Franken did charity shows for the Wellstone Campaign that year that kept the phones hooked up and the lights on. In the half quarter Franken just reported, the 1.3 million he raised is .2 million more than the whole 1990 Wellstone campaign cost!!! And the whole idea that Al should run for the Wellstone Seat next year emerged from discussion during a break of the board for Wellstone Action among Al, Walter Mondale and others -- but it originated with Molly Ivins who just blurted out -- "Al, you ought to move home and run for the Senate." So yea, if he wins it will be yet one more grand idea that can be ascribed to Molly. In the summer of 2002 Paul was saying that if he won re-election he wanted to write another book about the practical politics of getting to a Universal Single Payer system -- and what I've outlined above were ideas he was playing around with at the time of his death. I think Franken has or will inherit most of Wellstone's close advisors and will see the need to push forward many of his ideas but with a Franken Flavor.

But what's really important, I think about all this is the understanding Wellstone developed of the institutional barriers to major reforms of the Health Care Industry. How to design it (so as to achieve mass acceptance) and how to understand the power of the opposition is just so missing in the normal debates.

Hi Sara: I really enjoy your perspective on things. Here's just a bit of history about how this happened in Canada, which I know about because my grandfather chaired the committee that planned the introduction of public hospital insurance in Ontario beginning in 1958. My grandfather was a member of the generation that came back from WWII determined that things would be different ... collectively, they undertook six national projects that represent that foundation for Canada's social infrastructure even to this day. (For details about that, see canadawewant.ca) In the case of health, the federal government offered in the late 50s to co-fund 50% of the cost of public hospital insurance. Under the Canadian constitution, health is a provincial responsibility, so each province had to decide for itself whether to go along. The conservative Premier of Ontario at the time, Leslie Frost, was a member of my father's congregation in Lindsay Ontario. He agonized over this decision, since he knew it would be expensive. Then the Premier got a letter from his private insurance company informing him that his private insurance would be cancelled in a few weeks on his 65th birthday. This probably didn't really influence his decision, but he spent the next two years claiming it did. How would you like to be the clerk who sent out that letter.

This is obviously much too long a story to tell here, but what is relevant to your point is that in Canada this transition was done in stages under the control of the provinces ... the first stage being public hospital insurance that covered medical care in hospitals, and the next stage, ten years later, being public health insurance that covered all medical care. Canada's single payer system has in fact 10 single payers (leaving aside the territories for now) ... each of the 10 provinces administers its own payments system.

Overall, this works well and is efficient. But the key issue we face now is that doctors are paid piece rate by procedure, and we really need a transition to a system that provides as much incentive to promote health as it currently does to treat disease. But that's an even longer story.

We sincerely hope that our American friends solve this problem in your country, since as a society you are paying 20% more than anyone else for lower population health outcomes ... and that is not good for you nor your Canadian friends.

The deli owner in me says knish.

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