More toward the health debate .. Single-payer health care
Single-payer health care is the payment of doctors, hospitals, and other health care providers from a single fund and is one of the systems used with universal health care. The administrator of the fund is usually the government. Australia's Medicare, Canada's health care system, the United Kingdom's National Health Service, and the United States' Medicare, Medicaid, and TRICARE are examples of single-payer health care. Single-payer universal health care on a national level is sometimes referred to in the U.S. as Medicare for All.
According to the National Library of Medicine's Medical Subject Headings (MeSH) thesaurus, a single-payer system is:
An approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company. The proposed advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs.
Some argue that the single-payer is the government, but the preceding definition, as well as some single-payer proponents in the U.S., leave the government's role open to interpretation. However, the term single-payer is never used to indicate that the patient bears sole responsibility for all payment.
Single-payer health care pays health professionals that are either in the private or public sector. It is also used to pay both privately and publicly owned health care facilities.
Single-payer is one alternative proposed for reforming the U.S. health care system. Supporters argue that it would provide universal coverage with at least the same quality and greatly lower costs. Some opponents, such as the conservative Heartland Institute, promote for-profit, free market approaches.
Contents .. 1 Types and variations .. 1.1 Canada .. 1.2 United States .. 1.2.1 State proposals .. and more .. and links ..
The United States, Canada and Australia have single-payer health insurance programs named Medicare; however, Australia's program provides universal health care, while U.S. Medicare is only for senior citizens and some of the disabled. Government is increasingly involved in U.S. health care spending, paying about 45 percent of the $2.2 trillion the nation spent on medical care in 2004.
According to Princeton University health economist Uwe E. Reinhardt, Medicare, Medicaid, and SCHIP represent "forms of 'social insurance' coupled with a largely private health-care delivery system" rather than forms of "socialized medicine." In contrast, he describes the Veterans Administration healthcare system as a pure form of socialized medicine because it is "owned, operated and financed by government."
The Veterans Administration is a single-payer system and provides excellent quality, said Reinhardt. In a peer-reviewed paper published in the Annals of Internal Medicine, researchers of the RAND Corp. reported that the quality of care received by Veterans Administration patients scored significantly higher overall than did comparable metrics for patients in the rest of the U.S. health system
Some writers describe publicly administered health care systems as "single-payer plans." Some writers have described any system of health care which intends to cover the entire population, such as voucher plans, as "single-payer plans," although this is an uncommon usage.
Canada .. Main article: Medicare (Canada) .. See also: Canadian and American health care systems compared
Canada's system is an example of single-payer health care. The national government provides part of the funding, provincial governments manage the hospitals (and provide the brunt of the funding), and doctors in private practice contract with the government for fee-for-service payments. Many Canadian citizens have supplemental health insurance, which covers expenses not covered by Canadian Medicare. Fees for doctors, hospitals and other providers are set by negotiations among doctors' associations, provincial or regional governments, and the national government. Global budgets eliminate the cost of billing individually for huge numbers of products and services.
The provision of health care in Canada is done mostly via private practitioners, although most hospitals are public. Patients may go to any doctor or hospital in the country.
United States .. See also: Health care reform in the United States and Health care in the United States
Health care in the United States .. Government
Centers for Medicare and Medicaid Services .. Medicare .. Medicaid .. Military Health System .. TRICARE .. Department of Veterans Affairs (VA) .. Indian Health Service .. State Children's Health Insurance Program (SCHIP) .. EMTALA .. Federal Employees Health Benefits Program
Reform .. Reform advocacy groups .. Private .. Health maintenance organization (HMO) .. Managed care .. Medical underwriting .. Preferred provider organization (PPO)
Private consumer driven .. Flexible spending account (FSA) .. Health Reimbursement Account .. Health savings account .. High Deductible Health Plan (HDHP) .. Medical savings account
Physicians for a National Health Program (PNHP) supports a single-payer system which would be an expanded and improved version of U.S. Medicare, and would cover every American for all necessary medical care. In 2007, The American College of Physicians, the second largest group of physicians in the USA, called for legally mandated coverage of all Americans and urged lawmakers to consider a single payer system as one option for achieving that goal. The American Medical Student Association also supports single-payer.
In Congress, Rep. John Conyers, Jr. (D-MI) has introduced the United States National Health Insurance Act (HR 676).
Converting to a single-payer system is seen by proponents as a solution to the flaws in the current U.S. system. The U.S. health care system is the most expensive in the world on both a per-capita basis and as a percentage of GDP. Despite this expenditure, the current U.S. system fails to provide universal coverage. More than 45 million Americans, about 15 percent of the population, lacked health insurance in 2007.[17] The lack of universal coverage contributes to another flaw in the current U.S. health care system: on most dimensions of performance, it under performs relative to other industrialized countries.
In a 2007 comparison by the Commonwealth Fund of health care in the U.S. with that of Germany, Britain, Australia, New Zealand, and Canada, the U.S. ranked last on measures of quality, access, efficiency, equity, and outcomes.
For example, U.S. ranks 22nd in infant mortality, between Taiwan and Croatia, 46th in life expectancy, between Saint Helena and Cyprus, and 37th in health system performance, between Costa Rica and Slovenia.
The U.S. system is often compared with that of its northern neighbor, Canada (see Canadian and American health care systems compared). Canada's system is largely publicly funded. In 2005, Americans spent an estimated US$6,401 per capita on health care, while Canadians spent US$3,326.[22] This amounted to 15.3% of U.S GDP in that year, while Canada spent 9.8% of GDP on health care.
A 2007 review of all studies comparing health outcomes in Canada and the U.S. found that "health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent."
Proponents of health care reform argue that moving to a single-payer system would reallocate the money currently spent on the administrative overhead required to run the hundreds of insurance companies in the U.S. to provide universal care. An often-cited study by Harvard Medical School and the Canadian Institute for Health Information determined that some 30 percent of U.S. health care dollars, or more than $1,000 per person per year, went to health care administrative costs.
Advocates say that a U.S. single-payer health care system would provide universal coverage, give patients free choice of providers and hospitals, and guarantee comprehensive coverage and equal access for all medically necessary procedures, without increasing overall spending. Shifting to a single-payer system would eliminate oversight by managed care reviewers, restoring the traditional doctor-patient relationship.
State proposals
California's Legislature has twice passed a state-level single payer bill, SB-840, "The California Universal Healthcare Act" (authored by Sheila Kuehl), in 2006 and again in 2008. Both times, Governor Arnold Schwarzenegger vetoed the bill. State Senator Mark Leno plans to introduce The California Universal Healthcare Act again, in 2009. In April 2008, the Illinois House of Representatives' Health Availability Access Committee passed the single-payer bill HB 311, "The Health Care for All Illinois Act,"[33] favorably out of committee by an 8-4 vote.
Several single-payer referendums have been proposed at the state level, but so far all have failed to pass: California in 1994, Massachusetts in 2000, and Oregon in 2002.
Hendra virus .. specific to Australia .. bat borne .. 4 died ..
Vet with Hendra virus dies in hospital By Petrina Berry, AAP September 2, 2009
The Australian Veterinary Association is calling for more research into the Hendra virus after the death of a second vet from the deadly disease.
Rockhampton vet Dr Alister Rodgers died after contracting the virus from a sick horse on a Cawarral stud farm, which is northeast of Rockhampton.
Mr Rodgers was in intensive care at the Princess Alexandra Hospital.
Health Minister Paul Lucas told state parliament on Wednesday Dr Rogers died overnight.
He is the fourth person to die from the bat-borne disease.
All seven in the world to contract the virus have been in Queensland
Dr Rodgers treated a foal at J4S horse nursery in Cawarral, that was originally believed to have died from a snake bite in July.
He leaves behind wife Linda and children, Courtney and Duncan.
Vet association president Mark Lawrie said the virus needs to be taken seriously by health and biosecurity authorities.
"We are really sad that we have lost another colleague and our sympathies go out to Alister's family and work mates," Dr Lawrie told AAP.
"It's a problem that's not going to go away. We have to change the way we do things.
"The veterinary community is calling on the government and the public at large to help us to deal with crises like these - emerging diseases are on the increase.
"We need to put resources and funding into researching this area.
"That's what's happening in the US and Europe. They are taking it seriously."
He said the vet community was already suffering cutbacks.
"We need funding for education and training for vets and horse owners specific to this virus," Dr Lawrie said.
Four other people who came into contact with infected horses were discharged from the Princess Alexandra Hospital at the weekend.
Property owner John Brady, stud manager Debbie Brown and fellow workers Angela Webber and Adrian Daniels were being monitored at the hospital as a precaution.
So far all four have tested negative but await more test results to be cleared. http://au.news.yahoo.com/a/-/latest/5904643/vet-with-hendra-virus-dies-in-hospital/ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Henipavirus .. excerpts .. Henipavirus is a genus of the family Paramyxoviridae, order Mononegavirales containing two members, Hendravirus and Nipahvirus. The henipaviruses are naturally harboured by Pteropid fruit bats (flying foxes) and are characterised by a large genome, a wide host range and their recent emergence as zoonotic pathogens capable of causing illness and death in domestic animals and humans.
Hendra virus
Emergence Hendra virus (originally Equine morbillivirus) was discovered in September 1994 when it caused the deaths of fourteen horses, and a trainer at a training complex in Hendra, a suburb of Brisbane in Queensland, Australia.
The index case, a mare, was housed with 23 other horses after falling ill and died two days later. Subsequently, 19 of the remaining horses succumbed with 13 dying. Both the trainer and a stable hand were involved in nursing the index case and both fell ill within one week of the horse’s death with an influenza-like illness. The stable hand recovered while the trainer died of respiratory and renal failure. The source of virus was most likely frothy nasal discharge from the index case.
A second outbreak occurred in August 1994 (chronologically preceding the first outbreak) in Mackay 1000 km north of Brisbane resulting in the deaths of two horses and their owner. The owner assisted in autopsies of the horses and within three weeks was admitted to hospital suffering from meningitis. He recovered, but 14 months later developed neurologic signs and died. This outbreak was diagnosed retrospectively by the presence of Hendra virus in the brain of the patient.
A survey of wildlife in the outbreak areas was conducted and identified pteropid fruit bats as the most likely source of Hendra virus with a seroprevalence of 47%. All of the other 46 species sampled were negative. Virus isolations from the reproductive tract and urine of wild bats indicated that transmission to horses may have occurred via exposure to bat urine or birthing fluids.
Outbreaks [all in Australia .. 8 Queensland .. 1 NSW]
A total of nine outbreaks of Hendra virus have occurred since 1994, all involving infection of horses. Four of these outbreaks have spread to humans as a result of direct contact with infected horses.
* August 1994, Mackay, Queensland: Death of two horses and one person.
* September 1994, Brisbane, Queensland: 14 horses died from a total of 20 infected. Two people infected with one death.
* January 1999, Cairns, Queensland: Death of one horse.
* October 2004, Cairns, Queensland: Death of one horse. A vet involved in autopsy of the horse was infected with Hendra virus and suffered a mild illness.
* December 2004, Townsville, Queensland: Death of one horse.
* June 2006, Sunshine Coast, Queensland: Death of one horse.
* October 2006, Murwillumbah, New South Wales: Death of one horse.
* July 2007, Clifton Beach, Queensland: Infection of one horse (euthanized).
* July 2008, Redlands, Brisbane, Queensland: Death of five horses; four died from the Henda virus, the remaining animal recovered but was euthanized as a health threat. Two veterinary workers from the affected property were infected leading to the death of one, veterinary surgeon Dr. Ben Cuneen, on the 20th of August, 2008. The second veterinarian was hospitalized after pricking herself with a needle she had used to euthanize the horse that had recovered. A nurse exposed to the disease while assisting Cuneen in caring for the infected horses was also hospitalized.
* July 2008, Cannonvale, Queensland: Death of two horses.
* August 2009, Cawarral, Queensland: Death of one horse; the death of three other horses is being investigated. Queensland veterinary surgeon Alister Rodgers tested positive after treating the horses.[14] On September 1, 2009 he became the fourth person to die from exposure to the virus.
The distribution of black and spectacled flying foxes covers the outbreak sites, and the timing of incidents indicates a seasonal pattern of outbreaks possibly related to the seasonality of fruit bat birthing. As there is no evidence of transmission to humans directly from bats, it is thought that human infection only occurs via an intermediate host.
Pathology
Flying foxes are unaffected by Hendra virus infection. Symptoms of Hendra virus infection of humans may be respiratory, including haemorrhage and oedema of the lungs, or encephalitic resulting in meningitis. In horses, infection usually causes pulmonary oedema and congestion.
Nipah virus
Emergence Pteropus vampyrus (Malayan flying fox), one of the natural reservoirs of Nipah virus
Nipah virus was identified in 1999 when it caused an outbreak of neurological and respiratory disease on pig farms in peninsular Malaysia, resulting in 105 human deaths and the culling of one million pigs. In Singapore, 11 cases including one death occurred in abattoir workers exposed to pigs imported from the affected Malaysian farms. The Nipah virus has been classified by the Centers for Disease Control and Prevention as a Category C agent (http://www.bt.cdc.gov/agent/agentlist-category.asp).
The outbreak was originally mistaken for Japanese encephalitis (JE), however, physicians in the area noted that persons who had been vaccinated against JE were not protected, and the number of cases among adults was unusual. Despite the fact that these observations were recorded in the first month of the outbreak, the Ministry of Health failed to react accordingly and instead launched a nationwide campaign to educate people on the dangers of JE and its vector, Culex mosquitoes.
Symptoms of infection from the Malaysian outbreak were primarily encephalitic in humans and respiratory in pigs. Later outbreaks have caused respiratory illness in humans, increasing the likelihood of human-to-human transmission and indicating the existence of more dangerous strains of the virus. .. continued ..
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