Is extension of medicare the right model for public health insurance. I am not an enthusaist for medicare. When I first broached it with my then internest really a family practise here i Leesburg, his response was straightforward. "Then I will no longer treat you."

From what I know, medicare is a better deal for physicians than private insurance when it comes to adminstrative hassles but they reimburse at really low levels. Yet it is my experience that they do not monitor the pill pushers nor do they have a differentiated approach to diagnostic tests. Internists get the worse deal but specialists and big Pharm and medigap insurers are doing well.

I think that any serious universal health plan should include a provision to pay education costs for all health care professionals including nurses, and aides and technicians. I the high premiums that doctors pay for malpractise insurance against patient claims are unfair to them. It forces doctors into a CYA mode. I believe that their should be some bettert way of dealing with malpractise and carelessness.

Joe Paduda has an interesting commentary on CAF, Medicare for All: The Wrong Answer to the Right Question. Here are a few excerpts:

The unfunded liability for future Medicare costs clearly and convincingly demonstrates that Medicare is not earning enough revenue to pay for future expense. In commercial insurance terms, they are dramatically under-reserved. Why? Premiums are not keeping pace with medical inflation, and Medicare is not controlling the primary driver of medical costs - utilization of services.

Here are a couple examples. Medicare's imaging expenses doubled between 2000 and 2007. Utilization of physician in-office services went up more than 10% in 2006. Back surgery rates for Medicare patients in Fort Myers Florida are five times higher than they are in Miami. And physician fees are scheduled to be cut 20.5% next January because total physician expenses under Medicare are way over budget. Not to mention the cost-shifting that currently has private insurers making up lost revenue from Medicare underpayments

He suggests a plan on the VA model:

- compared to commercial managed care plans, the VA provided diabetics with better quality care on seven out of eight metrics (NCQA report).

- In 2005, VA hospitals were the highest-rated health system, outperforming other systems including the Mayo Clinic and Johns Hopkins.

- the VA achieves higher scores than private hospitals for patient satisfaction, staffing levels, surgical volume and other significant quality measures

- for six years running, VA hospitals scored higher than private facilities on the University of Michigan's American Customer Satisfaction Index.

And costs haven't increased nearly as fast as they have in the private sector. In the ten years ending in 2005, the number of veterans receiving treatment from the VA more than doubled, from 2.5 million to 5.3 million, but the agency needed 10,000 fewer employees to deliver that care - as a result the cost per patient stayed flat. (costs for care in the private sector jumped 60% over the same period).

The VA did this by closing down unneeded facilities, developing an industry-leading electronic health record system, opening clinics, and dramatically increasing the quality of care, especially for patients with chronic conditions.

Oh, and patients can access their own health records - securely - anytime on the web.