"Obamacare is a radical expansion of the status quo." —JD Kleinke
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| Sept 2012 |
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| December 2025 |
BTW: Noted medical economist / novelist JD Kleinke is my friend (fellow guitar cat). He once told me "an economist is someone who sees something that works in practice and tries to determine whether it'll work in theory."
OK, BACK UP TO 1994
My first grad school paper. An "argument analysis & evaluation" assessment of the "Single Payer" proposal published in JAMA.
UNLV EPS 701 Fall 1994, Argument Analysis Paper (pdf)
A Better Quality Alternative:
Single-Payer National Health System Reform
Gordon D. Schiff, MD, Andrew M. Bindman, MD, Troyen A. Brennan, MD, JD, MPH;
Physicians for a National Health Program Quality of Care Working Group.
JAMA, September 14, 1994—VoL 272, No. 10
Argument synopsis:
Notwithstanding public misgivings about making significant public policy driven changes in the U.S. health care industry, there is extensive and persuasive empirical evidence of costly inadequacies in the system—such as lack of access/coverage, uneven levels of quality of service and outcomes, market-driven rather clinical priorities, waste and duplication, etc.—that can best be corrected by a unified approach to improvement driven by a scientific focus on quality issues (broadly defined) rather than those of short-term cost-control, competition, and piecemeal regulatory strategies and tactics. A single-payer health care system reformed by implementation of the ten principles detailed herein would at once extend medical access to all, reduce costs, improve clinical outcomes of the sick and injured, and elevate the overall health status of the nation, resulting in win-win consequences for providers and citizens alike.
I first flowcharted every declarative sentence / sub-clause "truth claim" sequentially to get at what the authors were precisely advocating ("seek first to understand'). Only after that would I go on to "evaluation" ("seek then to be understood")—basically making my argument going to the cogency of the proffer. (Basically, think "ASSUMING - BECAUSE - DESPITE - THEREFORE - ELSE" logic and concomitant evidence)
I had at least 100 hours in that paper. Great fun. Notwithstanding a 2nd grad course in "History of Ethics" (11 required textbooks) and my day gig at the Nevada Medicare Peer Review.
I'm revisiting my conclusions (to wit, pg 54).
Overall Evaluation:
The following alternative courses of action are generally advanced in the health care debate:No one can dispute that the health care industry can be improved. Any system an be improved. Problems such as lack of access, arbitrary and often wildly excessive pricing, inexplicable variations in clinical practice and outcomes are well-documented and cry out for solution. That tends to rule out option 1. The question is one of extent: has the case been made that the health care industry requires comprehensive national reform?
- Status quo: the system works fine, and normal incremental quality improvements at the provider level will suffice. Get a job.
- Insurance reform: prohibit exclusion and enforce community rating to reduce the insurance premium stratification characteristic of the present system.
- Expand existing public payer programs such as Medicare to cover the working poor and otherwise uninsurable.
- Capitated managed competition, with "employer mandates" to provide choices in beneficiary alliances for pooled coverage bry*g power, administered though the workplace.
- Tax inducement programs such as the "Medi-save" approach in which workers use pre-tax dollars to purchase catastrophic coverage and pay for routine health expenses themselves.
- The public single-payer system based more or less on the Canadian model.
I've been gumshoeing this topic for a long time. e.g., see "Public Optional."
Stay tuned...






















