None of the major candidates are proposing anything close to a single payor system. All of their proposals rely primarily on regulation of the insurance industry and tax incentives. John Edward's' proposal is the most detailed to date. They are all too complex to be effectively comprehensive. They all talk about cost containment, but none of them really detail how medical costs are to be contained. None of them really recognize the need to equitably distribute the national cost of medical care, or recognize the inefficiencies and extremely high administrative costs involved with a heavily-regulated private system involving many different private insurances, each with their own set of internal rules, regulations and documentation requirements.

Our current 'system' mostly functions by cost shifting the price of treatment for medical conditions, and denial or limiting of preventive care to anyone who is uninsured, and many who are insured. Increasingly, even Medicaid recipients are being denied care by virtue of co-pays they do not have the means to meet. people on fixed incomes with only Medicare can not afford adequate care.

Many private practitioners in mental health do not deal with insurance. The private practice partnership I have just started is not going to. Too much administrative overhead for the practice to be viable. If there was one, dominant insurance company in the area to deal with, we probably would opt to take that one insurance. But we are not about to tackle dealing with 5 or 6 or 10 different companies. Because the three of us all come from the public mental health arena we wanted to take Medicaid. But the record keeping for that is too complex, and the reimbursement rate too low.   We could not collect enough to cover the cost of providing services. There are a small but growing number of general medical practices that are opting out of taking insurances for the same reason. That 'some one else', currently, is the tax payer, and not the profit taker (and providers of medical care are not, by and large, the predominant profit takers.) But because it is all this shifting, unackowleged process, it is hidden and not understood by the general public.

When a Medicaid recipient or an uninsured person avoids earlier care, and then ends up at the ER, really, really sick, the cost gets shifted to some one else. When a patient can not afford medications, and gets them through a patient assistance program, or, as we do at our clinic, through month after month of 'samples' (andboy,do we ever work the drug reps. to keep our sample closet filled,) that cost gets shifted to someone else.

I am not a proponent of completely socialized medicine. But as a person with experience as both a consumer and provider, our current dual systems do not work, and none of the candidates are proposing an integrated system that will work. They are all way too heavily weighted toward capitalism and profit-taking by the few at the expense of the many, and do not provide for anything that approaches the necessity of a more equitable distribution of the costs, risks, and benefits that would make for a viable plan. I say, let the tax payer (me, you, most of us) assume most of the costs and the risks, but be transparent about it. Then, let us also reap more of the benefits in the form of adequate health care for all.

That ain't a'gonna happen soon. In the meantime, any of the proposals of the major candidates are better than what, as a society, we have now. If we are gonna reinvent the wheel, let's get on with it.

Janie